Provider Demographics
NPI:1568062164
Name:KREMLING, MAYA ELIZABETH LEE
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:ELIZABETH LEE
Last Name:KREMLING
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 1:2269 CAFFREY CT
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5496
Mailing Address - Country:US
Mailing Address - Phone:330-703-0546
Mailing Address - Fax:
Practice Address - Street 1:10626 DURREY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8192
Practice Address - Country:US
Practice Address - Phone:330-703-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7719061172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver