MEDICARE: KATHLEEN DIEDALIS CST/CSFA

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
1	246ZC0007X	Surgical Assistant		OH

General Provider Information

NPI Number	:	1366578981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DIEDALIS CST/CSFA

Provider Business Mailing Address
First Line	:	893 MENDES CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3506
Country	:	US
Telephone Number	:	614-824-5200
Fax Number	:	888-329-6432

Provider Business Practice Location Address
First Line	:	893 MENDES CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3506
Country	:	US
Telephone Number	:	614-824-5200
Fax Number	:	888-329-6432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	12/10/2014

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