1891998977 NPI number — KATHY MEYER FENZL OT

Table of content: KATHY MEYER FENZL OT (NPI 1891998977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891998977 NPI number — KATHY MEYER FENZL OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENZL
Provider First Name:
KATHY
Provider Middle Name:
MEYER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYER
Provider Other First Name:
KATHY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891998977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
525 HWY 150
Provider Business Mailing Address City Name:
ARROYO SECO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87514-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-776-1418
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 HWY 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARROYO SECO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87514-8751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-776-1418
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

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: 225X00000X , with the licence number:  2231 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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