=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356730121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY MCCARTHY-CODY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2015
-----------------------------------------------------
Last Update Date | 01/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 ELM ST
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-221-7468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 ELM ST
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-221-7468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP-SP-TMP-4132
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------