Healthcare Provider Details

I. General information

NPI: 1851722409
Provider Name (Legal Business Name): KATHY KOTOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 VILLAGE PARK DR
POWELL OH
43065-6606
US

IV. Provider business mailing address

503 VILLAGE PARK DR
POWELL OH
43065-6606
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-8009
  • Fax: 614-448-9475
Mailing address:
  • Phone: 614-846-8009
  • Fax: 614-448-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: