=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790288520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATI OREA BARTHOLOMEW PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2018
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 CENTRE ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02302-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-941-7299
-----------------------------------------------------
Fax | 508-941-6299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 533 WEBSTER ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02050-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-808-4405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------