Provider Demographics
NPI:1720645849
Name:TATMAN, TABITHA ANN (MT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:TATMAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 SW 4TH TER
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-8456
Mailing Address - Country:US
Mailing Address - Phone:785-418-3343
Mailing Address - Fax:
Practice Address - Street 1:215 N VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2055
Practice Address - Country:US
Practice Address - Phone:316-323-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS41522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist