Provider Demographics
NPI:1982141651
Name:KORBARIYACHIT, TITI
Entity Type:Individual
Prefix:
First Name:TITI
Middle Name:
Last Name:KORBARIYACHIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BALDWIN ST
Mailing Address - Street 2:APT 9
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3251
Mailing Address - Country:US
Mailing Address - Phone:304-376-4691
Mailing Address - Fax:
Practice Address - Street 1:380 BALDWIN ST
Practice Address - Street 2:APT 9
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3251
Practice Address - Country:US
Practice Address - Phone:304-376-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program