Healthcare Provider Details

I. General information

NPI: 1669301115
Provider Name (Legal Business Name): KIRSTEN HAUTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W TOWNLINE ST
PAYNE OH
45880-9361
US

IV. Provider business mailing address

835 N WILLIAMS ST
PAULDING OH
45879-1064
US

V. Phone/Fax

Practice location:
  • Phone: 419-263-2512
  • Fax:
Mailing address:
  • Phone: 419-399-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: