Provider Demographics
NPI:1114148830
Name:MANSEL, KATHRYN O (M)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:O
Last Name:MANSEL
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:O
Other - Last Name:HIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-4440
Mailing Address - Fax:330-543-4467
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4440
Practice Address - Fax:330-543-4467
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics