Provider Demographics
NPI:1699561563
Name:EVERSOLE, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:EVERSOLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MANN RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9455
Mailing Address - Country:US
Mailing Address - Phone:937-733-7798
Mailing Address - Fax:
Practice Address - Street 1:505 MANN RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9455
Practice Address - Country:US
Practice Address - Phone:937-733-7798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant