Healthcare Provider Details

I. General information

NPI: 1821782392
Provider Name (Legal Business Name): TIA ROCHELLE BERRY KINSEY C.C.M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 REED RD APT M
BEAVERCREEK OH
45440-4558
US

IV. Provider business mailing address

11400 BRANCH LN
MIAMISBURG OH
45342-0809
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-0958
  • Fax:
Mailing address:
  • Phone: 513-393-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: