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NPI Code Detail

MEDICARE: MRS. KATHRYN A FEDDELER OTR

MEDICARE: MRS. KATHRYN A FEDDELER OTR
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
1174400000XSpecialistAA435511MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AA435511OTHERCOOT LICENSE

General Provider Information

NPI Number : 1073817011
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN A FEDDELER OTR
Provider Business Mailing Address
First Line : 1690 SMOKE RIDGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-3489
Country : US
Telephone Number : 719-599-7289
Fax Number :
Provider Business Practice Location Address
First Line : 1690 SMOKE RIDGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-3489
Country : US
Telephone Number : 719-599-7289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2011
Last Update Date : 01/05/2011

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