Provider Demographics
NPI:1669067427
Name:RUTLEDGE, TANAIJAH
Entity type:Individual
Prefix:
First Name:TANAIJAH
Middle Name:
Last Name:RUTLEDGE
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 1:4910 KOGER BLVD APT 3D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2794
Mailing Address - Country:US
Mailing Address - Phone:910-546-5885
Mailing Address - Fax:
Practice Address - Street 1:601 S. MARTIN LUTHER KING JR. DRIVE
Practice Address - Street 2:F.L ATKINS BUILDING
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27110
Practice Address - Country:US
Practice Address - Phone:336-750-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist