Provider Demographics
NPI:1710971452
Name:MOLITOR, KIMBERLY KAY (AUD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14722 ROAD 51
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-9544
Mailing Address - Country:US
Mailing Address - Phone:419-258-2760
Mailing Address - Fax:
Practice Address - Street 1:1035 W WAYNE ST
Practice Address - Street 2:SUITE 10
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1544
Practice Address - Country:US
Practice Address - Phone:419-399-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01298231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2516432Medicaid
OH2516432Medicaid
OHBU9346241Medicare PIN