1720651763 NPI number — KATIE J PARKER MT-BC

Table of content: KATIE J PARKER MT-BC (NPI 1720651763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720651763 NPI number — KATIE J PARKER MT-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
KATIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT-BC
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:
1720651763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/27/2021
NPI Reactivation Date:
09/23/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 PLAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REHOBOTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02769-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-405-6412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ERDMAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-860-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2021

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: 225A00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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