MEDICARE: MRS. DORTHA HOLCOMB

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710584636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORTHA HOLCOMB

Provider Business Mailing Address
First Line	:	859 MEDFORD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1311
Country	:	US
Telephone Number	:	216-297-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 MEDFORD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1311
Country	:	US
Telephone Number	:	216-297-1774
Fax Number	:

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

Provider Enumeration Date	:	10/04/2020
Last Update Date	:	10/04/2020

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Directions to “ MRS. DORTHA HOLCOMB ” Practice Location

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