MEDICARE: KATHLEEN M STOTTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	AT-AT-365107	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AT-AT-365107	OTHER	OR	LICENSE

General Provider Information

NPI Number	:	1023169828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M STOTTS

Provider Business Mailing Address
First Line	:	2621 CROSBY AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-5726
Country	:	US
Telephone Number	:	541-883-6406
Fax Number	:	541-883-6247

Provider Business Practice Location Address
First Line	:	2621 CROSBY AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-5726
Country	:	US
Telephone Number	:	541-883-6406
Fax Number	:	541-883-6247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN M STOTTS ” Practice Location

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