MEDICARE: KMW MODIFICATIONS

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1972743508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMW MODIFICATIONS

Provider Business Mailing Address
First Line	:	6997 RAMBLEHURST RD
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-3548
Country	:	US
Telephone Number	:	419-841-3095
Fax Number	:	419-841-3095

Provider Business Practice Location Address
First Line	:	6997 RAMBLEHURST RD
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-3548
Country	:	US
Telephone Number	:	419-841-3095
Fax Number	:	419-841-3095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KRISTIN M. WILHELMI
Credential	:
Telephone Number	:	419-841-3095

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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