Healthcare Provider Details

I. General information

NPI: 1235909961
Provider Name (Legal Business Name): MRS. TAYLOR KREMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 BELL HOLLOW RD
LATHAM OH
45646-9715
US

IV. Provider business mailing address

328 BELL HOLLOW RD
LATHAM OH
45646-9715
US

V. Phone/Fax

Practice location:
  • Phone: 740-648-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: