1093175853 NPI number — KATELYN KESSLER EVERHART MOT, OTR

Table of content: KATELYN KESSLER EVERHART MOT, OTR (NPI 1093175853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093175853 NPI number — KATELYN KESSLER EVERHART MOT, OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVERHART
Provider First Name:
KATELYN
Provider Middle Name:
KESSLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KESSLER
Provider Other First Name:
KATELYN
Provider Other Middle Name:
MARIE
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:
1093175853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 E 51ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46205-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-494-3958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9919 TOWNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-8260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-872-4166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2016

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:  31006166A , 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)





Copyright © 2007-2025 www.npivalidator.com