Healthcare Provider Details

I. General information

NPI: 1730721101
Provider Name (Legal Business Name): TAWANA JULIUS SPECIALISTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11497 SPRINGFIELD PIKE STE 5
SPRINGDALE OH
45246-3551
US

IV. Provider business mailing address

11497 SPRINGFIELD PIKE STE 5
SPRINGDALE OH
45246-3551
US

V. Phone/Fax

Practice location:
  • Phone: 513-306-3282
  • Fax:
Mailing address:
  • Phone: 513-306-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCOSA.092404
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberCOSA.092404
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCOSA.092404
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: