MEDICARE: TIA JAVONNE EVANS

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

General Provider Information

NPI Number	:	1538927389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA JAVONNE EVANS

Provider Business Mailing Address
First Line	:	1059 ADDICE WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2701
Country	:	US
Telephone Number	:	513-328-3177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 ADDICE WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2701
Country	:	US
Telephone Number	:	513-328-3177
Fax Number	:

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

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ TIA JAVONNE EVANS ” Practice Location

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