Most Relevant Information
Provider Data
| NPI Number: | 1003379744 |
| Provider Name: | KAITLYN DESELMS |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: | CDCA.170150 |
Most Important Dates
| Enumeration Date: | 04/10/2019 |
| Last Updated: | 04/10/2019 |
Provider Practice Location
7140 PORT SYLVANIA DR
TOLEDO
OH
436171176
Practice Location Phone/Fax
| Phone: | 4194754449 |
| Fax: |
Provider Mailing Location
7140 PORT SYLVANIA DR
TOLEDO
OH
436171176
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |