1659364370 NPI number — DEBORAH ELAINE KRATZ OTD, OTR/L

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659364370 NPI number — DEBORAH ELAINE KRATZ OTD, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRATZ
Provider First Name:
DEBORAH
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTD, 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:
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:
1659364370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6121 CASTLEBROOKE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28356-8042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-995-7695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6121 CASTLEBROOKE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28356-8042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-995-7695
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2005

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:  072-0000378 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 6344 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11453890 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3478998 . This is a "AETNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1008318 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: EMI5816501 . This is a "VMC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 5816501 . This is a "FAHC PREFERRED" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 58507 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0509091 . This is a "CIGNA--CORRECTION" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 750214 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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