Provider Demographics
NPI:1932454600
Name:AGNITSCH, KIMBERLY (RRT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:AGNITSCH
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:IL
Mailing Address - Zip Code:62874-0064
Mailing Address - Country:US
Mailing Address - Phone:618-218-2606
Mailing Address - Fax:
Practice Address - Street 1:207 N MADISON ST.
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:IL
Practice Address - Zip Code:62874-0064
Practice Address - Country:US
Practice Address - Phone:618-218-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1940058962279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care