Provider Demographics
NPI:1194082560
Name:MAPLE, KATHLEEN MARIE (LAC, DIPL AC (NCCAOM)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MAPLE
Suffix:
Gender:F
Credentials:LAC, DIPL AC (NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9513
Mailing Address - Country:US
Mailing Address - Phone:330-203-0535
Mailing Address - Fax:
Practice Address - Street 1:5603 DARROW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5020
Practice Address - Country:US
Practice Address - Phone:330-528-0034
Practice Address - Fax:330-528-3149
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist