Provider Demographics
NPI:1780286864
Name:NEIL ADAMS, NATASHA ANTOINETTE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANTOINETTE
Last Name:NEIL ADAMS
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 1:1665 DUXBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1050
Mailing Address - Country:US
Mailing Address - Phone:614-373-3753
Mailing Address - Fax:
Practice Address - Street 1:1665 DUXBERRY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1050
Practice Address - Country:US
Practice Address - Phone:614-373-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
OH33.022610225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist