Provider Demographics
NPI:1104616556
Name:PUTNAM, TEASIA MINYEA
Entity type:Individual
Prefix:
First Name:TEASIA
Middle Name:MINYEA
Last Name:PUTNAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3057
Mailing Address - Country:US
Mailing Address - Phone:234-380-9002
Mailing Address - Fax:
Practice Address - Street 1:1919 9TH ST SW
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3057
Practice Address - Country:US
Practice Address - Phone:234-380-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide