1508919838 NPI number — MRS. CATHEY MAE KAHLIE MS PT

Table of content: MRS. CATHEY MAE KAHLIE MS PT (NPI 1508919838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508919838 NPI number — MRS. CATHEY MAE KAHLIE MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHLIE
Provider First Name:
CATHEY
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
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:
1508919838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 NE DOCTORS DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-6324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-382-5500
Provider Business Mailing Address Fax Number:
541-389-5669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 SW CYBER DR
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-382-5500
Provider Business Practice Location Address Fax Number:
541-389-5669
Provider Enumeration Date:
01/19/2007

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:  2365 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 274012 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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