MEDICARE: DOR'CHELLE TIARA SIMPSON N/A

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	253Z00000X	In Home Supportive Care Agency		OH

General Provider Information

NPI Number	:	1649850744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOR'CHELLE TIARA SIMPSON N/A

Provider Business Mailing Address
First Line	:	3413 DOUGLAS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2018
Country	:	US
Telephone Number	:	567-331-4513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 DOUGLAS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2018
Country	:	US
Telephone Number	:	567-331-4513
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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