Healthcare Provider Details

I. General information

NPI: 1245268580
Provider Name (Legal Business Name): KATHY J ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 MAIN ST
GREENVILLE PA
16125-2106
US

IV. Provider business mailing address

198 MAIN ST
GREENVILLE PA
16125-2106
US

V. Phone/Fax

Practice location:
  • Phone: 724-589-0262
  • Fax: 724-589-5975
Mailing address:
  • Phone: 724-589-0262
  • Fax: 724-589-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC18354
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: