1881069821 NPI number — MRS. KATIE ALANE SIMONDS CERTIFIED OCCUPATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881069821 NPI number — MRS. KATIE ALANE SIMONDS CERTIFIED OCCUPATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONDS
Provider First Name:
KATIE
Provider Middle Name:
ALANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED OCCUPATION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EMEWEIN
Provider Other First Name:
KATIE
Provider Other Middle Name:
ALANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881069821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SHAWNEE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-999-2030
Provider Business Mailing Address Fax Number:
419-991-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 LANGMAID LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-362-6090
Provider Business Practice Location Address Fax Number:
814-362-2841
Provider Enumeration Date:
12/02/2015

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: 224ZR0403X , with the licence number:  OP006355 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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