Provider Demographics
NPI:1144863184
Name:SCHULZE, KELLY M
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:SCHULZE
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 1:3872 TAUTON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5824
Mailing Address - Country:US
Mailing Address - Phone:614-371-0856
Mailing Address - Fax:
Practice Address - Street 1:3872 TAUTON CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-5824
Practice Address - Country:US
Practice Address - Phone:614-371-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171W00000XOther Service ProvidersContractor
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
47399000443221A002OtherTRICARE