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NPI Code Detail

MEDICARE: EBONY LASTER

MEDICARE: EBONY LASTER
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
1225700000XMassage Therapist33.023392OH

General Provider Information

NPI Number : 1700425493
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY LASTER
Provider Business Mailing Address
First Line : 6792 HARRISON AVE APT 45
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-3219
Country : US
Telephone Number : 513-362-0052
Fax Number :
Provider Business Practice Location Address
First Line : 3268 JEFFERSON AVE # 1
Second Line :
City : CINCINNATI
State : OH
Zip : 45220-2220
Country : US
Telephone Number : 513-362-0052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2019
Last Update Date : 12/30/2019

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Directions to “ EBONY LASTER ” Practice Location

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