Healthcare Provider Details

I. General information

NPI: 1851714182
Provider Name (Legal Business Name): VANIETY CHERELLE REID HAIR PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 EAST MAIN ST LOFT 26
WHITEHALL OH
43213
US

IV. Provider business mailing address

6321 JAMES ROUSE BLVD
CANAL WINCHESTER OH
43110-9676
US

V. Phone/Fax

Practice location:
  • Phone: 330-941-0493
  • Fax: 614-298-4025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: