MEDICARE: CAROLYN NICHOLE MOTLEY

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	164W00000X	Licensed Practical Nurse	122466	OH

General Provider Information

NPI Number	:	1508278607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN NICHOLE MOTLEY

Provider Business Mailing Address
First Line	:	1267 W GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1267 W GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5555
Country	:	US
Telephone Number	:	513-238-7354
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	07/15/2021

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Directions to “ CAROLYN NICHOLE MOTLEY ” Practice Location

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