Provider Demographics
NPI:1518470681
Name:BLAIR, RACINE CYNTHIA I (CERTIFIEDHAIRLOSSSPE)
Entity Type:Individual
Prefix:MS
First Name:RACINE
Middle Name:CYNTHIA
Last Name:BLAIR
Suffix:I
Gender:F
Credentials:CERTIFIEDHAIRLOSSSPE
Other - Prefix:MS
Other - First Name:RACINE
Other - Middle Name:CYNTHIA
Other - Last Name:BLAIR
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:NOISETTE HAIR
Mailing Address - Street 1:4043 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7047
Mailing Address - Country:US
Mailing Address - Phone:216-406-1177
Mailing Address - Fax:
Practice Address - Street 1:23054 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5135
Practice Address - Country:US
Practice Address - Phone:216-406-1177
Practice Address - Fax:216-406-1177
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82-33790331744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management