Provider Demographics
NPI:1124617329
Name:PHILLIPS, TAMI J
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:PHILLIPS
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 1:249 BIRCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8905
Mailing Address - Country:US
Mailing Address - Phone:740-858-7347
Mailing Address - Fax:
Practice Address - Street 1:249 BIRCH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8905
Practice Address - Country:US
Practice Address - Phone:740-858-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide