Healthcare Provider Details

I. General information

NPI: 1083332860
Provider Name (Legal Business Name): MAIMOUNA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 SHAWNA CT
LIBERTY TOWNSHIP OH
45044-9675
US

IV. Provider business mailing address

6071 SHAWNA CT
LIBERTY TOWNSHIP OH
45044-9675
US

V. Phone/Fax

Practice location:
  • Phone: 513-962-3941
  • Fax:
Mailing address:
  • Phone: 513-962-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: