Provider Demographics
NPI:1235127697
Name:TENLEY, KATHLEEN SUSAN (ATC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:TENLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 PICCADILLY PL
Mailing Address - Street 2:APT D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1542
Mailing Address - Country:US
Mailing Address - Phone:614-899-9174
Mailing Address - Fax:
Practice Address - Street 1:700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3947
Practice Address - Country:US
Practice Address - Phone:614-224-1090
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer