=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184322661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KASEY HELMSTETTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2023
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 RED OAK
-----------------------------------------------------
City | CRIDERSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-645-5114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16301 NOTTINGHAM DR
-----------------------------------------------------
City | WAPAKONETA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45895-9470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-356-7492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 013060
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------