1013227560 NPI number — MS. DIANNA R TAIT LMT, BCTMB

Table of content: MS. DIANNA R TAIT LMT, BCTMB (NPI 1013227560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013227560 NPI number — MS. DIANNA R TAIT LMT, BCTMB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAIT
Provider First Name:
DIANNA
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT, BCTMB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013227560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1888 RIDGEVIEW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48198-9490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-483-6994
Provider Business Mailing Address Fax Number:
734-971-1360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1888 RIDGEVIEW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48198-9490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-483-6994
Provider Business Practice Location Address Fax Number:
734-971-1360
Provider Enumeration Date:
10/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  530489-07 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 7501000286 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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