MEDICARE: KATHERINE LEIGH GRIFFIN C.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife		TX

General Provider Information

NPI Number	:	1033495213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LEIGH GRIFFIN C.P.M.

Provider Business Mailing Address
First Line	:	4133 SCALES ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5394
Country	:	US
Telephone Number	:	512-280-6768
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 SCALES ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5394
Country	:	US
Telephone Number	:	512-280-6768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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