Provider Demographics
NPI:1043778616
Name:FARMER, PAIGE M (RKT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:FARMER
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 KEEWAYDIN DR
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-1919
Mailing Address - Country:US
Mailing Address - Phone:440-667-1710
Mailing Address - Fax:
Practice Address - Street 1:53 KEEWAYDIN DR
Practice Address - Street 2:
Practice Address - City:TIMBERLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-1919
Practice Address - Country:US
Practice Address - Phone:440-667-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2048226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty