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General NPI Number Information
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NPI Number | 1649896226
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Entity Type | Individual
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Provider Name | KATE FOX COLIE
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Gender | Female
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 11650 RIVERSIDE DR PENTHOUSE 1, SECOND FLOOR
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City | STUDIO CITY
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State | CA
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Zip | 91602-1093
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Country | US
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Telephone | 818-964-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 12331 RIVERSIDE DR APT 7
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3635
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Country | US
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Telephone | 818-964-1144
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 28395
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License Number State | CA
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