MEDICARE: KATARA SHENEE THOMAS

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	376K00000X	Nurse's Aide	400705330108	OH

General Provider Information

NPI Number	:	1154702322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATARA SHENEE THOMAS

Provider Business Mailing Address
First Line	:	4751 COUNTRY LN APT A16
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5834
Country	:	US
Telephone Number	:	216-785-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 COUNTRY LN APT A16
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5834
Country	:	US
Telephone Number	:	216-785-4665
Fax Number	:

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

Provider Enumeration Date	:	06/14/2015
Last Update Date	:	06/14/2015

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