Provider Demographics
NPI:1881958312
Name:TUTHILL, BEVERLY M
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:TUTHILL
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 1:34570 STATE HIGHWAY 10 STE 1
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-4142
Mailing Address - Country:US
Mailing Address - Phone:607-865-6783
Mailing Address - Fax:
Practice Address - Street 1:34570 STATE HIGHWAY 10 STE 1
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-4142
Practice Address - Country:US
Practice Address - Phone:607-865-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272409891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist