=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255524344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN L TODD, D.O., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 05/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 LAKE HOWELL RD
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-691-3960
-----------------------------------------------------
Fax | 407-691-3961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 LAKE HOWELL RD
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-691-3960
-----------------------------------------------------
Fax | 407-691-3961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. KATHLEEN L TODD
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 407-678-5554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS7722
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------