Provider Demographics
NPI:1306200712
Name:VEIDT, KELLI LYNN
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:VEIDT
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 1:720 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2476
Mailing Address - Country:US
Mailing Address - Phone:937-283-2186
Mailing Address - Fax:937-283-2187
Practice Address - Street 1:720 ELM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2476
Practice Address - Country:US
Practice Address - Phone:937-283-2186
Practice Address - Fax:937-283-2187
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0008312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer