Provider Demographics
NPI:1457798639
Name:CIESLAK, KATHERINE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:CIESLAK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12136 S PINE DR
Mailing Address - Street 2:#232
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12136 S PINE DR
Practice Address - Street 2:#232
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1697
Practice Address - Country:US
Practice Address - Phone:440-823-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer