Provider Demographics
NPI:1285378760
Name:TAFT, THERESE M
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:TAFT
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 1:19875 CENTER RIDGE RD APT 250
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3641
Mailing Address - Country:US
Mailing Address - Phone:440-724-9487
Mailing Address - Fax:
Practice Address - Street 1:19875 CENTER RIDGE RD APT 250
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3641
Practice Address - Country:US
Practice Address - Phone:440-724-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant