Provider Demographics
NPI:1225885965
Name:SEGGERSON, TIA BETHANY (INDEPENDENT AIDE)
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:BETHANY
Last Name:SEGGERSON
Suffix:
Gender:F
Credentials:INDEPENDENT AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CHEW RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8861
Mailing Address - Country:US
Mailing Address - Phone:419-632-4076
Mailing Address - Fax:
Practice Address - Street 1:1017 CHEW RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-8861
Practice Address - Country:US
Practice Address - Phone:409-632-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide