Healthcare Provider Details

I. General information

NPI: 1952957805
Provider Name (Legal Business Name): KHALIA MAPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7787 JOAN DR
WEST CHESTER OH
45069-3682
US

IV. Provider business mailing address

7787 JOAN DR
WEST CHESTER OH
45069-3682
US

V. Phone/Fax

Practice location:
  • Phone: 513-780-5780
  • Fax:
Mailing address:
  • Phone: 513-780-5780
  • Fax: 513-755-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33024419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: