Provider Demographics
NPI:1700635323
Name:WOLFGANG, KAITLYN NELEH
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:NELEH
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:NELEH
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5714 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9014
Mailing Address - Country:US
Mailing Address - Phone:419-709-2444
Mailing Address - Fax:
Practice Address - Street 1:781 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1165
Practice Address - Country:US
Practice Address - Phone:740-263-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013370225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant