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NPI Code Detail

MEDICARE: MS. OCTAVIA DESHAUN RICHARDSON LPTA

MEDICARE: MS. OCTAVIA DESHAUN RICHARDSON LPTA
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
1225200000XPhysical Therapy Assistant06426OH

General Provider Information

NPI Number : 1093831729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. OCTAVIA DESHAUN RICHARDSON LPTA
Provider Business Mailing Address
First Line : 13204 GRIFFING AVE APT 7
Second Line :
City : CLEVELAND
State : OH
Zip : 44120-3080
Country : US
Telephone Number : 216-921-0981
Fax Number :
Provider Business Practice Location Address
First Line : 20265 EMERY RD
Second Line :
City : NORTH RANDALL
State : OH
Zip : 44128-4122
Country : US
Telephone Number : 216-584-2720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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