Provider Demographics
NPI:1770269953
Name:SWAIN, TABITHA DANYELLE (MA-OCL)
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:DANYELLE
Last Name:SWAIN
Suffix:
Gender:
Credentials:MA-OCL
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:DANYELLE
Other - Last Name:SOUTHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 ALLENE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1935
Mailing Address - Country:US
Mailing Address - Phone:269-303-0538
Mailing Address - Fax:
Practice Address - Street 1:445 W MICHIGAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3749
Practice Address - Country:US
Practice Address - Phone:269-303-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator