Provider Demographics
NPI:1548095185
Name:DILLARD-BAITY, THOSHA (LPN)
Entity type:Individual
Prefix:
First Name:THOSHA
Middle Name:
Last Name:DILLARD-BAITY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 ROCKSIDE RD # 220
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4525
Mailing Address - Country:US
Mailing Address - Phone:704-682-7919
Mailing Address - Fax:
Practice Address - Street 1:733 W MARKET ST STE B5A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1009
Practice Address - Country:US
Practice Address - Phone:234-706-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175208.MEDS-IV164W00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty