Healthcare Provider Details

I. General information

NPI: 1760811772
Provider Name (Legal Business Name): KITTY LYNN TEMPLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5156 BLAZER PKWY SUITE 100
DUBLIN OH
43017-7317
US

IV. Provider business mailing address

5156 BLAZER PKWY SUITE 100
DUBLIN OH
43017-7317
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-7360
  • Fax: 614-889-7358
Mailing address:
  • Phone: 614-889-7360
  • Fax: 614-889-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number33.009379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: