Provider Demographics
NPI:1669842480
Name:MILETIC, KATHLEEN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MILETIC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2824
Mailing Address - Country:US
Mailing Address - Phone:765-215-5044
Mailing Address - Fax:
Practice Address - Street 1:203 N EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2824
Practice Address - Country:US
Practice Address - Phone:765-215-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020715 L-M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2LGP506600OtherAETNA