Healthcare Provider Details

I. General information

NPI: 1093641904
Provider Name (Legal Business Name): CARRIE RANEE KLOTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 HAMILTON MASON RD
FAIRFIELD TOWNSHIP OH
45011-5307
US

IV. Provider business mailing address

2878 GOODWIN SCHOOLHOUSE RD
BETHEL OH
45106-9420
US

V. Phone/Fax

Practice location:
  • Phone: 513-894-8888
  • Fax:
Mailing address:
  • Phone: 513-550-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: