Provider Demographics
NPI:1366598567
Name:BASIEWICZ, KARI LYNN (ATC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYNN
Last Name:BASIEWICZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 ALMONT DR
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6433 ALMONT DR
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3654
Practice Address - Country:US
Practice Address - Phone:216-676-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0008882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer