Provider Demographics
NPI:1750018388
Name:LIVELY, KATHY A
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:LIVELY
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 1:94 CINDY DR
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-8705
Mailing Address - Country:US
Mailing Address - Phone:740-645-0672
Mailing Address - Fax:
Practice Address - Street 1:94 CINDY DR
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-8705
Practice Address - Country:US
Practice Address - Phone:740-645-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant