MEDICARE: HELEN LOUISE VISLOSKY PTA

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	3747P1801X	Personal Care Attendant	01228	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01228	OTHER	OH	STATE OF OHIO

General Provider Information

NPI Number	:	1376864116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN LOUISE VISLOSKY PTA

Provider Business Mailing Address
First Line	:	1236 PHILLIPS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2635
Country	:	US
Telephone Number	:	937-903-5966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 PHILLIPS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2635
Country	:	US
Telephone Number	:	937-903-5966
Fax Number	:

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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