Healthcare Provider Details

I. General information

NPI: 1679188171
Provider Name (Legal Business Name): TECOLA R HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 CHANDLER ST
CINCINNATI OH
45227-1917
US

IV. Provider business mailing address

6325 CHANDLER ST
CINCINNATI OH
45227-1917
US

V. Phone/Fax

Practice location:
  • Phone: 513-257-4995
  • Fax: 513-440-6208
Mailing address:
  • Phone: 513-257-4995
  • Fax: 513-440-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number3124103
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3124103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: