Healthcare Provider Details

I. General information

NPI: 1851051403
Provider Name (Legal Business Name): QUEEN CITY PELVIC HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7745 5 MILE RD
CINCINNATI OH
45230-2355
US

IV. Provider business mailing address

1068 PORTWAY DR
CINCINNATI OH
45255-4477
US

V. Phone/Fax

Practice location:
  • Phone: 513-238-0952
  • Fax:
Mailing address:
  • Phone: 513-238-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RAKHI SRIVASTAVA
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 513-238-0952