1124145800 NPI number — MRS. KATIE M SEYMOUR MPT

Table of content: MRS. KATIE M SEYMOUR MPT (NPI 1124145800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124145800 NPI number — MRS. KATIE M SEYMOUR MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEYMOUR
Provider First Name:
KATIE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRUEGER
Provider Other First Name:
KATIE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124145800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST SIMONS ISLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31522-8281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-361-6536
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601A DEMERE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST SIMONS ISLAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31522-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-634-9945
Provider Business Practice Location Address Fax Number:
912-638-1584
Provider Enumeration Date:
03/26/2007

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: 225100000X , with the licence number:  PT007583 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT007583 . This is a "THERAPIST LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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