1245535095 NPI number — MRS. CATHERINE CLARE SMITH OTR

Table of content: MRS. CATHERINE CLARE SMITH OTR (NPI 1245535095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245535095 NPI number — MRS. CATHERINE CLARE SMITH OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CATHERINE
Provider Middle Name:
CLARE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNAMARA
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
CLARE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245535095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700
Provider Second Line Business Mailing Address:
ROUTE 302 PINE BUSH SCHOOLS
Provider Business Mailing Address City Name:
PINE BUSH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-744-2031
Provider Business Mailing Address Fax Number:
845-744-2241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 302
Provider Second Line Business Practice Location Address:
PINE BUSH SCHOOLS
Provider Business Practice Location Address City Name:
PINE BUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-744-2031
Provider Business Practice Location Address Fax Number:
845-744-2241
Provider Enumeration Date:
01/25/2011

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: 225X00000X , with the licence number:  004492-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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