Provider Demographics
NPI:1740887819
Name:PHILLIPS, TAMI RAE (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:RAE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 BRITTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2803
Mailing Address - Country:US
Mailing Address - Phone:330-733-2245
Mailing Address - Fax:330-733-6522
Practice Address - Street 1:552 BRITTAIN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2803
Practice Address - Country:US
Practice Address - Phone:330-733-2245
Practice Address - Fax:330-733-6522
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH330-733-2245Medicaid