Provider Demographics
NPI:1174975254
Name:MIDDLETON, KATHERINE RENEE (DIPL OM LAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:DIPL OM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4615 BYERS RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9607
Mailing Address - Country:US
Mailing Address - Phone:419-566-8530
Mailing Address - Fax:
Practice Address - Street 1:5780 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9014
Practice Address - Country:US
Practice Address - Phone:419-566-8530
Practice Address - Fax:419-866-2325
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65000357171100000X
CA583388-09225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist