Individual
ELIZABETH MARIE TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
830 STATE RD, GENEVA, OH 44041-9319
(440) 361-0162
Mailing address
830 STATE RD, GENEVA, OH 44041-9319
(440) 361-0162
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/24/2025
Last updated
05/24/2025
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