Healthcare Provider Details

I. General information

NPI: 1992470132
Provider Name (Legal Business Name): KERICE LYNN PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 ERIE AVE
CINCINNATI OH
45208-2135
US

IV. Provider business mailing address

2715 OBSERVATORY AVE
CINCINNATI OH
45208-2107
US

V. Phone/Fax

Practice location:
  • Phone: 513-926-6375
  • Fax:
Mailing address:
  • Phone: 513-926-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.024997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: