MEDICARE: VICTORIA DENISE AUTMAN

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	3747A0650X	Attendant Care Provider		OH

General Provider Information

NPI Number	:	1902625544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DENISE AUTMAN

Provider Business Mailing Address
First Line	:	2254 VERMONT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1443
Country	:	US
Telephone Number	:	419-975-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 VERMONT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1443
Country	:	US
Telephone Number	:	419-975-7004
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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