Provider Demographics
NPI:1023517919
Name:GEORGE, KATHLEEN FRANCES (CPHT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:FRANCES
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:1188 E HOWE ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12395 MCCRACKEN RD STE A
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2946
Practice Address - Country:US
Practice Address - Phone:216-587-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH10082765183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10082765OtherPTCB