Provider Demographics
NPI:1043619398
Name:KLINE, TAVITTA C
Entity type:Individual
Prefix:MRS
First Name:TAVITTA
Middle Name:C
Last Name:KLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAVITTA
Other - Middle Name:C
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:5223 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1431
Mailing Address - Country:US
Mailing Address - Phone:888-507-9816
Mailing Address - Fax:
Practice Address - Street 1:5223 THOMAS ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1431
Practice Address - Country:US
Practice Address - Phone:888-507-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401139310810376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide