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NPI Code Detail

MEDICARE: JATOYA BOSTOCK

MEDICARE: JATOYA BOSTOCK
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
1171WH0202XHome Modifications ContractorOH

General Provider Information

NPI Number : 1245643592
Entity Type Code : Individual
Provider Name (Legal Business Name) : JATOYA BOSTOCK
Provider Business Mailing Address
First Line : 4932 HACKETT DR
Second Line :
City : DAYTON
State : OH
Zip : 45417-6237
Country : US
Telephone Number : 937-718-3322
Fax Number :
Provider Business Practice Location Address
First Line : 4932 HACKETT DR
Second Line :
City : DAYTON
State : OH
Zip : 45417-6237
Country : US
Telephone Number : 937-718-3322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2014
Last Update Date : 07/03/2014

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Directions to “ JATOYA BOSTOCK ” Practice Location

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