Provider Demographics
NPI:1669687703
Name:STINSON, KATHLEEN E
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:STINSON
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 1:8150 ROAD 15
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9626
Mailing Address - Country:US
Mailing Address - Phone:419-523-4011
Mailing Address - Fax:419-523-9353
Practice Address - Street 1:8150 ROAD 15
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875
Practice Address - Country:US
Practice Address - Phone:419-523-4011
Practice Address - Fax:419-523-9353
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2115357Medicaid