Provider Demographics
NPI:1831680966
Name:HEMPHILL, TABATHA (LMBT)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 GOOSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-8322
Mailing Address - Country:US
Mailing Address - Phone:828-475-6745
Mailing Address - Fax:
Practice Address - Street 1:138 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3441
Practice Address - Country:US
Practice Address - Phone:828-475-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist