Provider Demographics
NPI:1962703785
Name:OBERT, KERRIE
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:OBERT
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 1:915 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3153
Mailing Address - Country:US
Mailing Address - Phone:614-366-5102
Mailing Address - Fax:
Practice Address - Street 1:565 METRO PL S
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5351
Practice Address - Country:US
Practice Address - Phone:614-366-3257
Practice Address - Fax:614-293-7292
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5284247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other