Healthcare Provider Details

I. General information

NPI: 1255746210
Provider Name (Legal Business Name): KATHLEEN HOWARD CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 PAESANOS PKWY SUITE 100
SHAVANO PARK TX
78231-1225
US

IV. Provider business mailing address

PO BOX 592442
SAN ANTONIO TX
78259-0172
US

V. Phone/Fax

Practice location:
  • Phone: 210-566-2333
  • Fax: 210-598-7268
Mailing address:
  • Phone: 210-566-2333
  • Fax: 210-598-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number2616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: