Provider Demographics
NPI:1497351043
Name:KOHLHORST, KIMBERLEE THERESE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:THERESE
Last Name:KOHLHORST
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 1:313 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9795
Mailing Address - Country:US
Mailing Address - Phone:419-591-9445
Mailing Address - Fax:
Practice Address - Street 1:313 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-9795
Practice Address - Country:US
Practice Address - Phone:419-591-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105151Medicaid