Provider Demographics
NPI:1093372211
Name:HOUSLEY INSTITUTE FOR RESTORATIVE INK
Entity Type:Organization
Organization Name:HOUSLEY INSTITUTE FOR RESTORATIVE INK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-490-3639
Mailing Address - Street 1:11729 WOODWIND DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1927
Mailing Address - Country:US
Mailing Address - Phone:513-490-3639
Mailing Address - Fax:
Practice Address - Street 1:11006 READING RD STE 102
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1981
Practice Address - Country:US
Practice Address - Phone:513-454-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty