Provider Demographics
NPI:1588241053
Name:SCHMITZ, KAYLEB
Entity type:Individual
Prefix:
First Name:KAYLEB
Middle Name:
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 MORROW WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PLAIN
Mailing Address - State:OH
Mailing Address - Zip Code:45162-9312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9722 MORROW WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT PLAIN
Practice Address - State:OH
Practice Address - Zip Code:45162-9312
Practice Address - Country:US
Practice Address - Phone:937-728-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care