Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34.010558 | OH |
N | 207QS0010X | Family Doctor - Sports Medicine | 34-010558 | OH |
NPI | 1245565944 |
---|---|
Provider Name | Kali Hollingsworth |
First Address | Dayton, OH 45459-7021 |
Second Address | Dayton, OH 45459-7021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 21/01/2021 |