Healthcare Provider Details

I. General information

NPI: 1487476545
Provider Name (Legal Business Name): LESLIE TIARA MCCAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HANCOCK AVE
DAYTON OH
45406-1646
US

IV. Provider business mailing address

1 OAKWOOD AVE UNIT 73
OAKWOOD OH
45409-7503
US

V. Phone/Fax

Practice location:
  • Phone: 937-581-4315
  • Fax:
Mailing address:
  • Phone: 513-882-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: