MEDICARE: TECOLA R HARRISON

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	3124103	OH
2	251C00000X	Developmentally Disabled Services Day Training Agency	3124103	OH

General Provider Information

NPI Number	:	1679188171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TECOLA R HARRISON

Provider Business Mailing Address
First Line	:	6325 CHANDLER ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1917
Country	:	US
Telephone Number	:	513-257-4995
Fax Number	:	513-440-6208

Provider Business Practice Location Address
First Line	:	6325 CHANDLER ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1917
Country	:	US
Telephone Number	:	513-257-4995
Fax Number	:	513-440-6208

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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Directions to “ TECOLA R HARRISON ” Practice Location

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