MEDICARE: MS. BRENDA SING-OTA L.P.C.C.

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	101YP2500X	Professional Counselor	E0700159	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31-0536968	OTHER	OH	TAX IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366777617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA SING-OTA L.P.C.C.

Provider Business Mailing Address
First Line	:	10979 REED HARTMAN HWY
Second Line	:	136B
City	:	BLUE ASH
State	:	OH
Zip	:	45242-2800
Country	:	US
Telephone Number	:	513-791-7284
Fax Number	:	513-791-9222

Provider Business Practice Location Address
First Line	:	10979 REED HARTMAN HWY
Second Line	:	136B
City	:	BLUE ASH
State	:	OH
Zip	:	45242-2800
Country	:	US
Telephone Number	:	513-791-7284
Fax Number	:	513-791-9222

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	11/15/2011

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