Provider Demographics
NPI:1154350445
Name:EINGLE, KATHERINE LEIGH
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEIGH
Last Name:EINGLE
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 1:465 W WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3412
Mailing Address - Country:US
Mailing Address - Phone:567-230-0063
Mailing Address - Fax:
Practice Address - Street 1:465 W WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3412
Practice Address - Country:US
Practice Address - Phone:567-230-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7400431OtherODMRDD CONTRACT #
OH2508441Medicaid