Provider Demographics
NPI:1649725409
Name:STEELE, TYNITA
Entity type:Individual
Prefix:
First Name:TYNITA
Middle Name:
Last Name:STEELE
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 1:5304 GAUTIER VANCLEAVE RD
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-4216
Mailing Address - Country:US
Mailing Address - Phone:228-326-0521
Mailing Address - Fax:228-205-0713
Practice Address - Street 1:5304 GAUTIER VANCLEAVE RD
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-4216
Practice Address - Country:US
Practice Address - Phone:228-326-0521
Practice Address - Fax:228-205-0713
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06-530021744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management