MEDICARE: KI'ARA CHAMBERS

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	405300000X	Prevention Professional	V6MHZN16F0	OH

General Provider Information

NPI Number	:	1043925456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KI'ARA CHAMBERS

Provider Business Mailing Address
First Line	:	1450 ALLEN AVE SE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-3988
Country	:	US
Telephone Number	:	234-322-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 ALLEN AVE SE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-3988
Country	:	US
Telephone Number	:	234-322-4666
Fax Number	:

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

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	01/19/2023

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Directions to “ KI'ARA CHAMBERS ” Practice Location

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