Provider Demographics
NPI:1427509215
Name:RHODEBACK, KARALYN TAYLOR
Entity type:Individual
Prefix:MISS
First Name:KARALYN
Middle Name:TAYLOR
Last Name:RHODEBACK
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 1:11962 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8543
Mailing Address - Country:US
Mailing Address - Phone:740-507-9214
Mailing Address - Fax:
Practice Address - Street 1:11962 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8543
Practice Address - Country:US
Practice Address - Phone:740-507-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer