MEDICARE: KATHERINE MINISEE

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	224Z00000X	Occupational Therapy Assistant	212975	TX

General Provider Information

NPI Number	:	1861881773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MINISEE

Provider Business Mailing Address
First Line	:	18903 PEBBLE LINKS CIR
Second Line	:	APT 205
City	:	TAMPA
State	:	FL
Zip	:	33647-1893
Country	:	US
Telephone Number	:	574-339-7558
Fax Number	:

Provider Business Practice Location Address
First Line	:	18903 PEBBLE LINKS CIR
Second Line	:	APT 205
City	:	TAMPA
State	:	FL
Zip	:	33647-1893
Country	:	US
Telephone Number	:	574-339-7558
Fax Number	:

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “ KATHERINE MINISEE ” Practice Location

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