Healthcare Provider Details

I. General information

NPI: 1538029392
Provider Name (Legal Business Name): KURTIS SCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DOUGLAS ST
TIFFIN OH
44883-1134
US

IV. Provider business mailing address

15 DOUGLAS ST
TIFFIN OH
44883-1134
US

V. Phone/Fax

Practice location:
  • Phone: 419-314-0500
  • Fax:
Mailing address:
  • Phone: 419-314-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: