Healthcare Provider Details

I. General information

NPI: 1669687703
Provider Name (Legal Business Name): MRS. KATHLEEN E STINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 ROAD 15
OTTAWA OH
45875
US

IV. Provider business mailing address

8150 ROAD 15
OTTAWA OH
45875-9626
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-4011
  • Fax: 419-523-9353
Mailing address:
  • Phone: 419-523-4011
  • Fax: 419-523-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: