MEDICARE: EMILY CHARLES M.A.

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	235Z00000X	Speech-Language Pathologist	2016033	OH

General Provider Information

NPI Number	:	1689041337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CHARLES M.A.

Provider Business Mailing Address
First Line	:	808 CLOUGH PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245
Country	:	US
Telephone Number	:	513-943-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 CLOUGH PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1715
Country	:	US
Telephone Number	:	513-943-6700
Fax Number	:

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

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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