1396819231 NPI number — MS. KATHLEEN NONE GUSKY-SHARP OTR

Table of content: MS. KATHLEEN NONE GUSKY-SHARP OTR (NPI 1396819231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396819231 NPI number — MS. KATHLEEN NONE GUSKY-SHARP OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUSKY-SHARP
Provider First Name:
KATHLEEN
Provider Middle Name:
NONE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUSKY-SHARP
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
NONE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396819231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 VISTA VIEW DR
Provider Second Line Business Mailing Address:
105 VISTA VIEW DR.,
Provider Business Mailing Address City Name:
CLOVERDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95425-3373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-894-7409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 VISTA VIEW DR
Provider Second Line Business Practice Location Address:
105 VISTA VIEW DR.,
Provider Business Practice Location Address City Name:
CLOVERDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95425-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-894-7409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006

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: 171W00000X , with the licence number:  CAOT#12 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CA 12 . This is a "NBCOT AA060681" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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