Provider Demographics
NPI:1649870924
Name:CHASE, TINA M
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CHASE
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 1:1817 STATE ROUTE 83 UNIT 478
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8948
Mailing Address - Country:US
Mailing Address - Phone:330-634-0447
Mailing Address - Fax:
Practice Address - Street 1:2825 RUSWIL DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-4465
Practice Address - Country:US
Practice Address - Phone:330-634-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant