Healthcare Provider Details

I. General information

NPI: 1013543701
Provider Name (Legal Business Name): KATEAU CERISME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAGNOLIA AVE
ORLANDO FL
32801-1624
US

IV. Provider business mailing address

320 N MAGNOLIA AVE
ORLANDO FL
32801-1624
US

V. Phone/Fax

Practice location:
  • Phone: 954-243-7478
  • Fax:
Mailing address:
  • Phone: 719-896-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCOS705761
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: