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General NPI Number Information
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NPI Number | 1356377592
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Entity Type | Individual
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Provider Name | MARY KAY LOCKWOOD ATC L
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1800 BARRS ST ST VINCENTS MEDICAL CENTER
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-308-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 126 TORTUGA LANE
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082
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Country | US
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Telephone | 904-254-9663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | AL1939
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License Number State | FL
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