Provider Demographics
NPI:1679952378
Name:SLYGH, TABITHA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:SLYGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ANN
Other - Last Name:KRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:400 E THIRD STREET
Mailing Address - Street 2:MSS 6AV-1
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8319
Mailing Address - Fax:
Practice Address - Street 1:502 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1913
Practice Address - Country:US
Practice Address - Phone:218-786-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist