Provider Demographics
NPI:1376310383
Name:KOSTYO, KAITLYN (RT(R)(M))
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KOSTYO
Suffix:
Gender:F
Credentials:RT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 IVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-4588
Mailing Address - Country:US
Mailing Address - Phone:440-668-3160
Mailing Address - Fax:
Practice Address - Street 1:5300 N MEADOWS DR STE 2900
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2546
Practice Address - Country:US
Practice Address - Phone:613-663-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10101562471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography