MEDICARE: FIERCELY REDEFINED DANCE TEAM

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255294666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIERCELY REDEFINED DANCE TEAM

Provider Business Mailing Address
First Line	:	8304 SEA MIST CT
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-9252
Country	:	US
Telephone Number	:	513-407-8005
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 PIPPIN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-2221
Country	:	US
Telephone Number	:	513-407-8005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARKESHA ANN WILLIAMS
Credential	:
Telephone Number	:	513-885-6065

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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