Healthcare Provider Details

I. General information

NPI: 1881305167
Provider Name (Legal Business Name): BLIP BEAUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 HAVENSPORT DR
CINCINNATI OH
45240-1853
US

IV. Provider business mailing address

9550 S MASON MONTGOMERY RD # 1040
MASON OH
45040-9759
US

V. Phone/Fax

Practice location:
  • Phone: 513-328-3177
  • Fax:
Mailing address:
  • Phone: 513-250-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TIA JAVONNE EVANS
Title or Position: OWNER
Credential:
Phone: 513-328-3177