Provider Demographics
NPI:1336741131
Name:FIELDHOUSE, KATRINA MARIE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:FIELDHOUSE
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 1:4090 SKYVIEW DR APT 177
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1254
Mailing Address - Country:US
Mailing Address - Phone:330-410-6718
Mailing Address - Fax:
Practice Address - Street 1:7844 STONE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8999
Practice Address - Country:US
Practice Address - Phone:330-722-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5211069Medicaid