Provider Demographics
NPI:1497176945
Name:KOSMIDER, CARMEN (LMT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KOSMIDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED RD
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9670
Mailing Address - Country:US
Mailing Address - Phone:419-320-1283
Mailing Address - Fax:
Practice Address - Street 1:8115 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MONCLOVA
Practice Address - State:OH
Practice Address - Zip Code:43542-9706
Practice Address - Country:US
Practice Address - Phone:419-320-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-01
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020534225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist