MEDICARE: CHERYL BLAKEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1003419789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL BLAKEMAN

Provider Business Mailing Address
First Line	:	4093 COLUMBIANA RD
Second Line	:
City	:	NEW SPRINGFIELD
State	:	OH
Zip	:	44443-9744
Country	:	US
Telephone Number	:	330-314-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	4093 COLUMBIANA RD
Second Line	:
City	:	NEW SPRINGFIELD
State	:	OH
Zip	:	44443-9744
Country	:	US
Telephone Number	:	330-314-2197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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Directions to “ CHERYL BLAKEMAN ” Practice Location

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