Provider Demographics
NPI:1619011921
Name:EYINK, KELLI L (LPT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:EYINK
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:1251 LINCOLN AVE
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0101
Mailing Address - Country:US
Mailing Address - Phone:419-738-9675
Mailing Address - Fax:419-738-9675
Practice Address - Street 1:1251 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9364
Practice Address - Country:US
Practice Address - Phone:419-738-9675
Practice Address - Fax:419-738-9675
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist