Healthcare Provider Details

I. General information

NPI: 1336897032
Provider Name (Legal Business Name): MISS KATE AVALEE BREIDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 FRAZEE AVE APT 10
BOWLING GREEN OH
43402-1922
US

IV. Provider business mailing address

624 FRAZEE AVE APT 10
BOWLING GREEN OH
43402-1922
US

V. Phone/Fax

Practice location:
  • Phone: 330-907-9898
  • Fax:
Mailing address:
  • Phone: 330-907-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: