1366721656 NPI number — KATHLEEN JULIA MONTOYA B.S. SLHS

Table of content: KATHLEEN JULIA MONTOYA B.S. SLHS (NPI 1366721656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366721656 NPI number — KATHLEEN JULIA MONTOYA B.S. SLHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTOYA
Provider First Name:
KATHLEEN
Provider Middle Name:
JULIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S. SLHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTOYA
Provider Other First Name:
KAT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.S. SLHS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366721656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 VENETIAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46901-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-437-9578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9909 E 100 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46936-9163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-628-0605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2011

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: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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