Provider Demographics
NPI:1851722409
Name:KOTOWSKI, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:KOTOWSKI
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 1:503 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6606
Mailing Address - Country:US
Mailing Address - Phone:614-846-8009
Mailing Address - Fax:614-448-9475
Practice Address - Street 1:503 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6606
Practice Address - Country:US
Practice Address - Phone:614-846-8009
Practice Address - Fax:614-448-9475
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH45-4369151Medicare PIN