1366731564 NPI number — MRS. KETURAH K PERKINS-TREMBLEY SLP

Table of content: MRS. KETURAH K PERKINS-TREMBLEY SLP (NPI 1366731564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366731564 NPI number — MRS. KETURAH K PERKINS-TREMBLEY SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS-TREMBLEY
Provider First Name:
KETURAH
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366731564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12816-0091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-796-8001
Provider Business Mailing Address Fax Number:
518-677-5651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 DUNBAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12816-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-796-8001
Provider Business Practice Location Address Fax Number:
518-677-5651
Provider Enumeration Date:
03/29/2011

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: 235Z00000X , with the licence number:  014635 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com