Individual
BO TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
729 6TH ST, PORTSMOUTH, OH 45662-4030
(740) 876-8290
(740) 529-1205
Mailing address
729 6TH ST, PORTSMOUTH, OH 45662-4030
(740) 876-8290
(740) 529-1205
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
003536
OH
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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