MEDICARE: MS. RACINE CYNTHIA BLAIR I CERTIFIEDHAIRLOSSSPE

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	1744P3200X	Prosthetics Case Management	82-3379033	OH

General Provider Information

NPI Number	:	1518470681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACINE CYNTHIA BLAIR I CERTIFIEDHAIRLOSSSPE

Provider Business Mailing Address
First Line	:	4043 WARRENSVILLE CENTER RD
Second Line	:
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7047
Country	:	US
Telephone Number	:	216-406-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	23054 EMERY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5135
Country	:	US
Telephone Number	:	216-406-1177
Fax Number	:	216-406-1177

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

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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