Provider Demographics
NPI:1902604903
Name:MCINTYRE, TANISHA MICHELLE
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:MICHELLE
Last Name:MCINTYRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TANISHA
Other - Middle Name:MICHELLE
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5010 CALIPH CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3105
Mailing Address - Country:US
Mailing Address - Phone:614-531-2797
Mailing Address - Fax:614-531-2797
Practice Address - Street 1:50 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5572
Practice Address - Country:US
Practice Address - Phone:937-430-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTNTN505026Medicaid