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NPI Code Detail

MEDICARE: MRS. KATHRYN ELLIS STURDIVANT ATC

MEDICARE: MRS. KATHRYN ELLIS STURDIVANT ATC
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
1246Z00000XOther Specialist/TechnologistJ3-0000268DE

General Provider Information

NPI Number : 1407391287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN ELLIS STURDIVANT ATC
Provider Business Mailing Address
First Line : 3600 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-3108
Country : US
Telephone Number : 302-798-6632
Fax Number :
Provider Business Practice Location Address
First Line : 3600 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-3108
Country : US
Telephone Number : 302-798-6632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2017
Last Update Date : 01/03/2017

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Directions to “ MRS. KATHRYN ELLIS STURDIVANT ATC” Practice Location

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