Provider Demographics
NPI:1063242014
Name:WELCH MILLISOR, KAITLIN JOHNELLE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JOHNELLE
Last Name:WELCH MILLISOR
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 1:221 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3607
Mailing Address - Country:US
Mailing Address - Phone:740-341-5772
Mailing Address - Fax:
Practice Address - Street 1:221 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3607
Practice Address - Country:US
Practice Address - Phone:740-341-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide