1548635584 NPI number — MRS. MARY KATHERINE YEAGER MS, OTR/L

Table of content: MRS. MARY KATHERINE YEAGER MS, OTR/L (NPI 1548635584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548635584 NPI number — MRS. MARY KATHERINE YEAGER MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEAGER
Provider First Name:
MARY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAWLEY
Provider Other First Name:
MARY
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSC, OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548635584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SHAWNEE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-999-2030
Provider Business Mailing Address Fax Number:
419-991-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 LANGMAID LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-362-6090
Provider Business Practice Location Address Fax Number:
814-362-2841
Provider Enumeration Date:
12/02/2015

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:  DC0043562 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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