Healthcare Provider Details

I. General information

NPI: 1477283547
Provider Name (Legal Business Name): KATLYNN PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 MERIDIAN AVE
SCRANTON PA
18504-2630
US

IV. Provider business mailing address

41 COUNTRY LN
WAYMART PA
18472-4595
US

V. Phone/Fax

Practice location:
  • Phone: 570-488-9800
  • Fax: 570-488-9802
Mailing address:
  • Phone: 570-488-9800
  • Fax: 570-488-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG014095
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: