Individual
MIRANDA TATOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3292 BENCHWOOD RD, DAYTON, OH 45414-2704
(937) 668-1729
Mailing address
3292 BENCHWOOD RD, DAYTON, OH 45414-2704
(937) 668-1729
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
06/25/2022
Last updated
06/25/2022
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