1134710312 NPI number — KATRINA MARIE FILLIAUX RBT

Table of content: KATRINA MARIE FILLIAUX RBT (NPI 1134710312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134710312 NPI number — KATRINA MARIE FILLIAUX RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FILLIAUX
Provider First Name:
KATRINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
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:
1134710312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
356C BROAD STREET, 3RD FLOOR
Provider Second Line Business Mailing Address:
ATTN REBECCA KHALIL
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-732-3982
Provider Business Mailing Address Fax Number:
888-589-1524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 GRANARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21050-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-836-7700
Provider Business Practice Location Address Fax Number:
888-589-1524
Provider Enumeration Date:
01/29/2021

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: 106S00000X , with the licence number:  RBT-21-151062 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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