Individual
TAJANIQUE FALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6180 ISLAND DR NW, CANTON, OH 44718-1609
(330) 224-8056
Mailing address
6180 ISLAND DR NW, CANTON, OH 44718-1609
(330) 224-8056
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
TX212106
OH
Other
Enumeration date
03/05/2026
Last updated
03/05/2026
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