Provider Demographics
NPI:1710199633
Name:BIRKEMEIER, KELLIE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:A
Last Name:BIRKEMEIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13013 S.R. 694
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875
Mailing Address - Country:US
Mailing Address - Phone:419-538-6296
Mailing Address - Fax:
Practice Address - Street 1:333 NORTH ST.
Practice Address - Street 2:SUITE102
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833
Practice Address - Country:US
Practice Address - Phone:419-692-0095
Practice Address - Fax:419-692-0097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist