MEDICARE: MRS. TIARA OTWORTH 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	171M00000X	Case Manager/Care Coordinator
2	164W00000X	Licensed Practical Nurse	LPN.157026.MEDS	OH

General Provider Information

NPI Number	:	1386295913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIARA OTWORTH LPN

Provider Business Mailing Address
First Line	:	2195 OAKES RD
Second Line	:
City	:	FRANKLIN FURNACE
State	:	OH
Zip	:	45629-8949
Country	:	US
Telephone Number	:	740-529-9489
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 OAKES RD
Second Line	:
City	:	FRANKLIN FURNACE
State	:	OH
Zip	:	45629-8949
Country	:	US
Telephone Number	:	740-529-9489
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	08/01/2023

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