Healthcare Provider Details

I. General information

NPI: 1619011921
Provider Name (Legal Business Name): KELLI L EYINK LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LINCOLN HWY
WAPAKONETA OH
45895-9364
US

IV. Provider business mailing address

PO BOX 101 1251 LINCOLN AVE
WAPAKONETA OH
45895-0101
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-9675
  • Fax: 419-738-9675
Mailing address:
  • Phone: 419-738-9675
  • Fax: 419-738-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: