Provider Demographics
NPI:1457015273
Name:PITTMAN, MICAH RHEANNON
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:RHEANNON
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:RHEANNON
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2727
Mailing Address - Country:US
Mailing Address - Phone:234-706-0067
Mailing Address - Fax:
Practice Address - Street 1:112 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2727
Practice Address - Country:US
Practice Address - Phone:234-706-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTX376654253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care