=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346472651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHY M POOL LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2009
-----------------------------------------------------
Last Update Date | 12/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 571 LINN ST
-----------------------------------------------------
City | CHILLICOTHEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45601-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-600-8376
-----------------------------------------------------
Fax | 740-851-6099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 571 LINN ST
-----------------------------------------------------
City | CHILLICOTHEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45601-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-600-8376
-----------------------------------------------------
Fax | 740-851-6099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN-096269-MEDS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------