Provider Demographics
NPI:1457950149
Name:CAUDILL, TABITHA LYNN
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LYNN
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-9095
Mailing Address - Country:US
Mailing Address - Phone:740-523-0129
Mailing Address - Fax:
Practice Address - Street 1:2538 COUNTY ROAD 55
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8893
Practice Address - Country:US
Practice Address - Phone:740-442-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide