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General NPI Number Information
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NPI Number | 1902614084
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Entity Type | Individual
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Provider Name | MARY KATLYN MINTON DS
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 631 GORDON DR
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City | CHARLESTON
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State | WV
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Zip | 25314-1751
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Country | US
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Telephone | 681-460-4571
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Fax |
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Provider Business Mailing Address
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Address Line | 631 GORDON DR
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City | CHARLESTON
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State | WV
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Zip | 25314-1751
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Country | US
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Telephone | 681-460-4571
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | WV
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