MEDICARE: MS. KEYATIA R ROBERSON

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1801592944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEYATIA R ROBERSON

Provider Business Mailing Address
First Line	:	19414 MAPLE HEIGHTS BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2380
Country	:	US
Telephone Number	:	216-538-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	19414 MAPLE HEIGHTS BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2380
Country	:	US
Telephone Number	:	216-538-4784
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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