MEDICARE: MARVELLA FRAZIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	347C00000X	Private Vehicle	OH
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	OH
3	253Z00000X	In Home Supportive Care Agency	OH

General Provider Information

NPI Number	:	1801402854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVELLA FRAZIER

Provider Business Mailing Address
First Line	:	5706 WHITE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3028
Country	:	US
Telephone Number	:	216-400-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 WHITE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3028
Country	:	US
Telephone Number	:	216-400-4666
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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Directions to “ MARVELLA FRAZIER ” Practice Location

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