Healthcare Provider Details

I. General information

NPI: 1043778616
Provider Name (Legal Business Name): PAIGE M FARMER RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 KEEWAYDIN DR
TIMBERLAKE OH
44095-1919
US

IV. Provider business mailing address

53 KEEWAYDIN DR
TIMBERLAKE OH
44095-1919
US

V. Phone/Fax

Practice location:
  • Phone: 440-667-1710
  • Fax:
Mailing address:
  • Phone: 440-667-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number2048
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: