Provider Demographics
NPI:1760269112
Name:MAICHL, KATHRYN GRACE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:MAICHL
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 1:2426 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2141
Mailing Address - Country:US
Mailing Address - Phone:480-338-3355
Mailing Address - Fax:
Practice Address - Street 1:2426 E 35TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2141
Practice Address - Country:US
Practice Address - Phone:480-338-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant