Healthcare Provider Details

I. General information

NPI: 1710806393
Provider Name (Legal Business Name): KATHERINE WEAN COF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 WESTGATE CENTER DR
WINSTON SALEM NC
27103-3040
US

IV. Provider business mailing address

1345 WESTGATE CENTER DR
WINSTON SALEM NC
27103-3040
US

V. Phone/Fax

Practice location:
  • Phone: 336-546-7165
  • Fax:
Mailing address:
  • Phone: 336-546-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC74490
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: