=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760237408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATARINA HARMON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2024
-----------------------------------------------------
Last Update Date | 04/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 TARLETON LN
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11768-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-719-6435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3787 FARR RD
-----------------------------------------------------
City | FRUITPORT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49415-9334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------