1952813347 NPI number — MRS. MARY KATHLEEN ESTEPP ATC/LAT

Table of content: MRS. MARY KATHLEEN ESTEPP ATC/LAT (NPI 1952813347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952813347 NPI number — MRS. MARY KATHLEEN ESTEPP ATC/LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTEPP
Provider First Name:
MARY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC/LAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCAULEY
Provider Other First Name:
MARY
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC/LAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952813347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 W THOMPSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENSSELAER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47978-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-457-9238
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 W THOMPSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENSSELAER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47978-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-457-9238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2017

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: 2255A2300X , with the licence number:  36002538A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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