MEDICARE: MS. PATRICIA WOOLARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant		OH

General Provider Information

NPI Number	:	1023415403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA WOOLARD

Provider Business Mailing Address
First Line	:	1413 E HENRY CLAY AVE
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-3723
Country	:	US
Telephone Number	:	513-609-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 E HENRY CLAY AVE
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-3723
Country	:	US
Telephone Number	:	513-609-1509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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