Provider Demographics
NPI:1437843273
Name:TEEMER, KANISHA
Entity type:Individual
Prefix:
First Name:KANISHA
Middle Name:
Last Name:TEEMER
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 1:7401 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5621
Mailing Address - Country:US
Mailing Address - Phone:866-897-4301
Mailing Address - Fax:
Practice Address - Street 1:940 COMPASS WEST DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3440
Practice Address - Country:US
Practice Address - Phone:330-787-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171400000X, 253Z00000X, 372600000X
246Y00000X, 332B00000X, 343900000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No171400000XOther Service ProvidersHealth & Wellness Coach
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372600000XNursing Service Related ProvidersAdult Companion