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NPI Code Detail

MEDICARE: KATELYN M BEERY

MEDICARE: KATELYN M BEERY
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
1106S00000XBehavior TechnicianRBT-19-107348IN

General Provider Information

NPI Number : 1346887734
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN M BEERY
Provider Business Mailing Address
First Line : 6131 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-4905
Country : US
Telephone Number : 260-459-6040
Fax Number :
Provider Business Practice Location Address
First Line : 500 N OAK ST
Second Line :
City : COLUMBIA CITY
State : IN
Zip : 46725-1218
Country : US
Telephone Number : 260-459-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2019
Last Update Date : 12/04/2019

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Directions to “ KATELYN M BEERY ” Practice Location

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