Provider Demographics
NPI:1639770308
Name:SCHACKMANN, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SCHACKMANN
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 1:2836 FAIRWAYS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8259
Mailing Address - Country:US
Mailing Address - Phone:513-235-6378
Mailing Address - Fax:
Practice Address - Street 1:2836 FAIRWAYS DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-8259
Practice Address - Country:US
Practice Address - Phone:513-235-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker