Provider Demographics
NPI:1871329029
Name:REITMEIER, KEVIN PHILLIP
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PHILLIP
Last Name:REITMEIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GREEN JACKET CT
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2271
Mailing Address - Country:US
Mailing Address - Phone:314-614-0871
Mailing Address - Fax:
Practice Address - Street 1:335 GREEN JACKET CT
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2271
Practice Address - Country:US
Practice Address - Phone:314-614-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty