Provider Demographics
NPI:1003417007
Name:YODER, KATIE M
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 COUNTY ROAD 77
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-7901
Mailing Address - Country:US
Mailing Address - Phone:330-275-4727
Mailing Address - Fax:
Practice Address - Street 1:6659 COUNTY ROAD 77
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-7901
Practice Address - Country:US
Practice Address - Phone:330-275-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant