MEDICARE: THOM DREW STEPHENSON

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	376J00000X	Homemaker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477209823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOM DREW STEPHENSON

Provider Business Mailing Address
First Line	:	7517 MIAMI AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-1929
Country	:	US
Telephone Number	:	513-731-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	7517 MIAMI AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-1929
Country	:	US
Telephone Number	:	513-731-6235
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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Directions to “ THOM DREW STEPHENSON ” Practice Location

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