MEDICARE: MISS JESSICA GRACE HOLIDAY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417988866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA GRACE HOLIDAY

Provider Business Mailing Address
First Line	:	2407 WIMBLEDON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4332
Country	:	US
Telephone Number	:	614-451-9628
Fax Number	:	614-451-0869

Provider Business Practice Location Address
First Line	:	2407 WIMBLEDON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4332
Country	:	US
Telephone Number	:	614-451-9628
Fax Number	:	614-451-0869

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/09/2007

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