Healthcare Provider Details

I. General information

NPI: 1497140602
Provider Name (Legal Business Name): KELLY OBRINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13609 CALIFORNIA ST
OMAHA NE
68154-5260
US

IV. Provider business mailing address

3248 SLAVIK RD
COLDWATER OH
45828-9752
US

V. Phone/Fax

Practice location:
  • Phone: 402-891-1118
  • Fax:
Mailing address:
  • Phone: 419-953-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.013972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: