MEDICARE: MRS. TIKISHA UNIQUE BILLUPS

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1447716881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIKISHA UNIQUE BILLUPS

Provider Business Mailing Address
First Line	:	6909 ENGLE RD
Second Line	:
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130-3473
Country	:	US
Telephone Number	:	440-403-9226
Fax Number	:	440-403-9276

Provider Business Practice Location Address
First Line	:	6909 ENGLE RD
Second Line	:
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130-3473
Country	:	US
Telephone Number	:	440-403-9226
Fax Number	:	440-403-9276

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

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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