Provider Demographics
NPI:1760219653
Name:MCGRADY, TESSA
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:MCGRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 KERMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-1511
Mailing Address - Country:US
Mailing Address - Phone:513-615-2087
Mailing Address - Fax:
Practice Address - Street 1:173 KERMIT AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1511
Practice Address - Country:US
Practice Address - Phone:513-615-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide