MEDICARE: DESARAE L WELLS

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	225700000X	Massage Therapist	33.025084	OH

General Provider Information

NPI Number	:	1730774001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESARAE L WELLS

Provider Business Mailing Address
First Line	:	1726 ASHBROOK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-4020
Country	:	US
Telephone Number	:	513-913-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 E KEMPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3322
Country	:	US
Telephone Number	:	513-913-5010
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	09/16/2021

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Directions to “ DESARAE L WELLS ” Practice Location

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