=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225944879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY REIFENBERGER
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 EATON AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45013-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-376-2082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 N DWYER RD
-----------------------------------------------------
City | OKEANA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45053-9363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | RN.525962
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------