Healthcare Provider Details

I. General information

NPI: 1043550197
Provider Name (Legal Business Name): LEAH KLINE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GREAT OAKS TRL
WADSWORTH OH
44281-9430
US

IV. Provider business mailing address

201 GREAT OAKS TRL
WADSWORTH OH
44281-9430
US

V. Phone/Fax

Practice location:
  • Phone: 330-336-9500
  • Fax: 330-336-3377
Mailing address:
  • Phone: 330-336-9500
  • Fax: 330-336-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: