1164523676 NPI number — MRS. KRISTEN ELIZABETH SABOL DPT

Table of content: MRS. KRISTEN ELIZABETH SABOL DPT (NPI 1164523676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164523676 NPI number — MRS. KRISTEN ELIZABETH SABOL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABOL
Provider First Name:
KRISTEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELAMATRE
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164523676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 W US RT 224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIFFIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-443-1429
Provider Business Mailing Address Fax Number:
419-443-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 W US RT 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFFIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-443-1429
Provider Business Practice Location Address Fax Number:
419-443-1691
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT011576 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1442035 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2527699 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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