Basic Information
| Provider Information | |||||||||
| NPI: | 1992389225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHLORHOLTZ | ||||||||
| FirstName: | KYLEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 N ERICKSON ST | ||||||||
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| City: | ROLAND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502361025 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2707 STANGE RD STE 102 | ||||||||
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| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500103965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159564014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2021 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 087884 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.