Provider Demographics
NPI:1225422025
Name:DOMOSLAWSKI, KAYLEE (RN, ATC)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:DOMOSLAWSKI
Suffix:
Gender:F
Credentials:RN, ATC
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5118 DIMSON DR N
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2412
Mailing Address - Country:US
Mailing Address - Phone:740-475-8115
Mailing Address - Fax:
Practice Address - Street 1:5118 DIMSON DR N
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2412
Practice Address - Country:US
Practice Address - Phone:740-475-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH471928163WP2201X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care