Provider Demographics
NPI:1528321528
Name:VARNEY, TABITHA E (SP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:E
Last Name:VARNEY
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KIDS PEACE WAY
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3483
Mailing Address - Country:US
Mailing Address - Phone:800-992-9543
Mailing Address - Fax:207-667-6348
Practice Address - Street 1:16 KIDS PEACE WAY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3483
Practice Address - Country:US
Practice Address - Phone:800-992-9543
Practice Address - Fax:207-667-6348
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST2182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist