Provider Demographics
NPI:1952000242
Name:KLEPATZKI FISHER, RITA CAROL
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:CAROL
Last Name:KLEPATZKI FISHER
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 1:407 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-2037
Mailing Address - Country:US
Mailing Address - Phone:330-401-9253
Mailing Address - Fax:
Practice Address - Street 1:407 W 3RD ST
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683-2037
Practice Address - Country:US
Practice Address - Phone:330-401-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH104919649499Medicaid