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Individual

TINA M KNISLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCDCIII

Contact information

Practice address
100 MEDICAL CENTER DR, SPRINGFIELD, OH 45504-2687
(937) 523-5363
(937) 523-5958
Mailing address
100 MEDICAL CENTER DR, SPRINGFIELD, OH 45504-2687
(937) 523-5363
(937) 523-5958

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001134
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00134
LCDCIII
OH
Enumeration date
06/20/2013
Last updated
06/20/2013
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