Healthcare Provider Details

I. General information

NPI: 1962045039
Provider Name (Legal Business Name): SAMUEL ROHAN ESHLEMAN LATIMER M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMUEL ROHAN MILLER-ESHLEMAN M.A.

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

994 DANA AVE APT 1
CINCINNATI OH
45229-1488
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-4673
  • Fax:
Mailing address:
  • Phone: 740-498-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: