1245639103 NPI number — MRS. DEANNA ELIZABETH KILMER KILMER, DEANNA PTA

Table of content: MRS. DEANNA ELIZABETH KILMER KILMER, DEANNA PTA (NPI 1245639103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245639103 NPI number — MRS. DEANNA ELIZABETH KILMER KILMER, DEANNA PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILMER
Provider First Name:
DEANNA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
KILMER, DEANNA PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DARRELL
Provider Other First Name:
DEANNA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245639103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 GREENFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTT TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18433-7761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-877-2127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 STURGES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PECKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18452-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-7230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2014

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: 225200000X , with the licence number:  TEI002320 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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