Provider Demographics
NPI:1306916929
Name:FRONK, TABITHA JUNE (MA, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:JUNE
Last Name:FRONK
Suffix:
Gender:F
Credentials:MA, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 GLENCOE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4039
Mailing Address - Country:US
Mailing Address - Phone:310-403-9317
Mailing Address - Fax:
Practice Address - Street 1:2232 GLENCOE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4039
Practice Address - Country:US
Practice Address - Phone:310-403-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-199221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist