Provider Demographics
NPI:1083211965
Name:KALTENBACH, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KALTENBACH
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 1:716 FRANKLIN AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1461
Mailing Address - Country:US
Mailing Address - Phone:304-588-8062
Mailing Address - Fax:
Practice Address - Street 1:716 FRANKLIN AVE APT A
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1461
Practice Address - Country:US
Practice Address - Phone:304-588-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant