Healthcare Provider Details

I. General information

NPI: 1225242944
Provider Name (Legal Business Name): CAROLE ANN PAINE MS CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 RIDGE AVE STE 4
CINCINNATI OH
45209-1075
US

IV. Provider business mailing address

145 HIGHLAND AVE
FORT THOMAS KY
41075-1632
US

V. Phone/Fax

Practice location:
  • Phone: 513-317-3660
  • Fax: 513-351-0928
Mailing address:
  • Phone: 859-581-7246
  • Fax: 859-581-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number013485
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65000014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: