1265874564 NPI number — MRS. KATHERINE LAGUENS HADDOCK ATC/L, OTC

Table of content: MRS. KATHERINE LAGUENS HADDOCK ATC/L, OTC (NPI 1265874564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265874564 NPI number — MRS. KATHERINE LAGUENS HADDOCK ATC/L, OTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDOCK
Provider First Name:
KATHERINE
Provider Middle Name:
LAGUENS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC/L, OTC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAGUENS
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC/L, OTC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265874564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 GULF BREEZE PKWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
GULF BREEZE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32561-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-916-8782
Provider Business Mailing Address Fax Number:
850-916-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-916-8782
Provider Business Practice Location Address Fax Number:
850-916-8458
Provider Enumeration Date:
07/27/2013

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:  AL2766 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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