MEDICARE: MRS. ASHLEY DIANE REICHENBACH LPN

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	246Z00000X	Other Specialist/Technologist		OH

General Provider Information

NPI Number	:	1114676939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY DIANE REICHENBACH LPN

Provider Business Mailing Address
First Line	:	935 N 12TH ST
Second Line	:
City	:	SEBRING
State	:	OH
Zip	:	44672-1543
Country	:	US
Telephone Number	:	330-581-2271
Fax Number	:

Provider Business Practice Location Address
First Line	:	2648 EASTON ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2655
Country	:	US
Telephone Number	:	330-956-4624
Fax Number	:

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

Provider Enumeration Date	:	03/20/2022
Last Update Date	:	03/20/2022

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