Healthcare Provider Details

I. General information

NPI: 1629590799
Provider Name (Legal Business Name): BY ANDREA D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 ALMESTER DR
CINCINNATI OH
45211-7603
US

IV. Provider business mailing address

2834 ALMESTER DR
CINCINNATI OH
45211-7603
US

V. Phone/Fax

Practice location:
  • Phone: 513-560-9624
  • Fax: 513-389-1605
Mailing address:
  • Phone: 513-560-9624
  • Fax: 513-389-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA WORTHAM
Title or Position: OWNER
Credential:
Phone: 513-560-9624