MEDICARE: MS. LOVIE EGGLESTON

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	COSI944534	OH

General Provider Information

NPI Number	:	1780968677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOVIE EGGLESTON

Provider Business Mailing Address
First Line	:	3431 LEE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3649
Country	:	US
Telephone Number	:	216-337-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	3431 LEE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3649
Country	:	US
Telephone Number	:	216-337-1559
Fax Number	:

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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Directions to “ MS. LOVIE EGGLESTON ” Practice Location

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