Provider Demographics
NPI:1063983617
Name:BOYKIN, TAMORA (COSMOTOLOGIST)
Entity type:Individual
Prefix:
First Name:TAMORA
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:COSMOTOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1648
Mailing Address - Country:US
Mailing Address - Phone:404-488-6642
Mailing Address - Fax:
Practice Address - Street 1:1830 WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1648
Practice Address - Country:US
Practice Address - Phone:404-488-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9923571744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management