Healthcare Provider Details

I. General information

NPI: 1699274415
Provider Name (Legal Business Name): TLT COSMETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 QUINN DR
NICHOLASVILLE KY
40356-1370
US

IV. Provider business mailing address

115 QUINN DR
NICHOLASVILLE KY
40356-1370
US

V. Phone/Fax

Practice location:
  • Phone: 859-881-0041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACIE TAYLOR
Title or Position: OWNER
Credential:
Phone: 859-881-0041