1912203084 NPI number — MS. KRISTINE LYNN OHLER B.S., P.T.A.

Table of content: MS. KRISTINE LYNN OHLER B.S., P.T.A. (NPI 1912203084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912203084 NPI number — MS. KRISTINE LYNN OHLER B.S., P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OHLER
Provider First Name:
KRISTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.S., P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912203084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-8327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-997-1155
Provider Business Mailing Address Fax Number:
301-997-1199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40900 MERCHANTS LN
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-3795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-1155
Provider Business Practice Location Address Fax Number:
301-997-1199
Provider Enumeration Date:
02/07/2011

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:  PTAA2289 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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