Provider Demographics
NPI:1609413350
Name:DOBBINS, KILA ANNISA MONAI
Entity Type:Individual
Prefix:
First Name:KILA
Middle Name:ANNISA MONAI
Last Name:DOBBINS
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 1:3490 SHADOW LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-4941
Mailing Address - Country:US
Mailing Address - Phone:216-973-9462
Mailing Address - Fax:
Practice Address - Street 1:3490 SHADOW LEDGE DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4941
Practice Address - Country:US
Practice Address - Phone:216-973-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer