1316179054 NPI number — KATHRYN A SEIFERT MOTR/L

Table of content: KATHRYN A SEIFERT MOTR/L (NPI 1316179054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316179054 NPI number — KATHRYN A SEIFERT MOTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIFERT
Provider First Name:
KATHRYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316179054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001-0421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-284-9779
Provider Business Mailing Address Fax Number:
860-409-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 SIMSBURY RD
Provider Second Line Business Practice Location Address:
BUILDING 12
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001-3760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-284-9779
Provider Business Practice Location Address Fax Number:
860-409-2190
Provider Enumeration Date:
08/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  003522 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)