Provider Demographics
NPI:1699542902
Name:ZUFALL, KAITLYN TAYLOR
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:TAYLOR
Last Name:ZUFALL
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 1:6918 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9593
Mailing Address - Country:US
Mailing Address - Phone:330-428-2440
Mailing Address - Fax:
Practice Address - Street 1:6918 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9593
Practice Address - Country:US
Practice Address - Phone:330-428-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0082379374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide