Healthcare Provider Details

I. General information

NPI: 1255294666
Provider Name (Legal Business Name): FIERCELY REDEFINED DANCE TEAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 PIPPIN RD
CINCINNATI OH
45231-2221
US

IV. Provider business mailing address

8304 SEA MIST CT
WEST CHESTER OH
45069-9252
US

V. Phone/Fax

Practice location:
  • Phone: 513-407-8005
  • Fax:
Mailing address:
  • Phone: 513-407-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARKESHA ANN WILLIAMS
Title or Position: OWNER
Credential:
Phone: 513-885-6065