Provider Demographics
NPI:1447752373
Name:WEEKES BOYLES, TABITHA ROSE
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ROSE
Last Name:WEEKES BOYLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-0092
Mailing Address - Country:US
Mailing Address - Phone:989-472-6333
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 92
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-0092
Practice Address - Country:US
Practice Address - Phone:989-472-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician