Provider Demographics
NPI:1215560420
Name:KELEMAN, KATELYN JOAN
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:JOAN
Last Name:KELEMAN
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 1:3020 AUSTINTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9758
Mailing Address - Country:US
Mailing Address - Phone:330-720-8617
Mailing Address - Fax:
Practice Address - Street 1:3020 AUSTINTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9758
Practice Address - Country:US
Practice Address - Phone:330-720-8617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011083225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant