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NPI Code Detail

MEDICARE: KAITLYN MARIE TOBELER LLBSW QIDP

MEDICARE:   KAITLYN MARIE TOBELER  LLBSW QIDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6802090066MI

General Provider Information

NPI Number : 1184286965
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN MARIE TOBELER LLBSW QIDP
Provider Business Mailing Address
First Line : 7178 LAKE VISTA DR SW APT 3A
Second Line :
City : BYRON CENTER
State : MI
Zip : 49315-9038
Country : US
Telephone Number : 734-383-5069
Fax Number :
Provider Business Practice Location Address
First Line : 7178 LAKE VISTA DR SW APT 3A
Second Line :
City : BYRON CENTER
State : MI
Zip : 49315-9038
Country : US
Telephone Number : 734-383-5069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2019
Last Update Date : 07/02/2019

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Directions to “ KAITLYN MARIE TOBELER LLBSW QIDP” Practice Location

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