Provider Demographics
NPI:1144706409
Name:SHOLL, KACEE LYNN (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KACEE
Middle Name:LYNN
Last Name:SHOLL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 WOODLAWN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1178
Mailing Address - Country:US
Mailing Address - Phone:419-599-0888
Mailing Address - Fax:419-599-0087
Practice Address - Street 1:1322 WOODLAWN AVE STE 1
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1178
Practice Address - Country:US
Practice Address - Phone:419-599-0888
Practice Address - Fax:419-599-0087
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist