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General NPI Number Information
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NPI Number | 1861358830
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Entity Type | Individual
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Provider Name | KATELYN OLDZIEJEWSKI
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Gender | Female
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 4079 TONGASS AVE STE 102
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City | KETCHIKAN
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State | AK
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Zip | 99901-5559
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Country | US
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Telephone | 907-308-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 178 HONEY JAR WAY
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City | LONGS
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State | SC
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Zip | 29568-9054
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Country | US
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Telephone | 570-899-0702
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP051717A
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License Number State | AK
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