Provider Demographics
NPI:1194562157
Name:JAMES, TISHA K
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:K
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:K
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 LARETA ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3007
Mailing Address - Country:US
Mailing Address - Phone:937-830-6435
Mailing Address - Fax:
Practice Address - Street 1:4 LARETA ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-3007
Practice Address - Country:US
Practice Address - Phone:937-830-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR627906347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle