Provider Demographics
NPI:1073116687
Name:OSTENDORF, KARLA J
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:J
Last Name:OSTENDORF
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 1:318 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2808
Mailing Address - Country:US
Mailing Address - Phone:937-231-9567
Mailing Address - Fax:
Practice Address - Street 1:318 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2808
Practice Address - Country:US
Practice Address - Phone:937-231-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109955Medicaid