Healthcare Provider Details

I. General information

NPI: 1033600556
Provider Name (Legal Business Name): CATHY JEAN SEELYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-2681
US

IV. Provider business mailing address

250 FOUSHEE HILL RD
GUSTON KY
40142-7138
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-54537
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: