MEDICARE: TAMORA BOYKIN COSMOTOLOGIST

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	1744P3200X	Prosthetics Case Management	992357	OH

General Provider Information

NPI Number	:	1063983617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMORA BOYKIN COSMOTOLOGIST

Provider Business Mailing Address
First Line	:	1830 WAKEFIELD DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1648
Country	:	US
Telephone Number	:	404-488-6642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 WAKEFIELD DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1648
Country	:	US
Telephone Number	:	404-488-6642
Fax Number	:

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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