Healthcare Provider Details

I. General information

NPI: 1538810254
Provider Name (Legal Business Name): BLESSED HANDS PHLEBOTOMY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 YOLANDA DR
DAYTON OH
45417-4467
US

IV. Provider business mailing address

2505 YOLANDA DR
DAYTON OH
45417-4467
US

V. Phone/Fax

Practice location:
  • Phone: 937-204-6762
  • Fax: 937-660-6876
Mailing address:
  • Phone: 937-204-6762
  • Fax: 937-660-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: KELYEA S DERRICKS
Title or Position: CPT
Credential: CPT,STNA
Phone: 937-204-6762