Provider Demographics
NPI:1558049205
Name:ADMYRHER EXTENTIONS
Entity Type:Organization
Organization Name:ADMYRHER EXTENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-952-9083
Mailing Address - Street 1:5667 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3972
Mailing Address - Country:US
Mailing Address - Phone:216-952-9083
Mailing Address - Fax:
Practice Address - Street 1:27970 CHAGRIN BLVD STE W222
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4461
Practice Address - Country:US
Practice Address - Phone:216-952-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier