Provider Demographics
NPI:1104352947
Name:MCCLELLAND, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCCLELLAND
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 1:224 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3242
Mailing Address - Country:US
Mailing Address - Phone:330-265-6801
Mailing Address - Fax:
Practice Address - Street 1:224 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3242
Practice Address - Country:US
Practice Address - Phone:330-265-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide