Provider Demographics
NPI:1962243113
Name:METZKER, KEVIN DALE
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DALE
Last Name:METZKER
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 1:283 DEWFALL DR
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8529
Mailing Address - Country:US
Mailing Address - Phone:614-425-0300
Mailing Address - Fax:
Practice Address - Street 1:283 DEWFALL DR
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8529
Practice Address - Country:US
Practice Address - Phone:614-425-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child