Provider Demographics
NPI:1932434339
Name:OAKLEY, TASHA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:OAKLEY
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 1:104 KENWOOD CT APT 1
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4707
Mailing Address - Country:US
Mailing Address - Phone:217-637-0399
Mailing Address - Fax:
Practice Address - Street 1:104 KENWOOD CT APT 1
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4707
Practice Address - Country:US
Practice Address - Phone:217-637-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider