MEDICARE: WILL TICHA

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		OH
2	172A00000X	Driver
3	3747P1801X	Personal Care Attendant	603014130725
4	106S00000X	Behavior Technician
5	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1528838174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILL TICHA

Provider Business Mailing Address
First Line	:	2000 TOWER OAKS BLVD
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4282
Country	:	US
Telephone Number	:	301-444-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 WAYCROSS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-3810
Country	:	US
Telephone Number	:	856-636-1128
Fax Number	:

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	03/04/2026

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Directions to “ WILL TICHA ” Practice Location

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