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NPI Code Detail

MEDICARE: MRS. KATHY ANN THERIOT

MEDICARE: MRS. KATHY ANN THERIOT
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1417229436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHY ANN THERIOT
Provider Business Mailing Address
First Line : 731 ZUNI ST
Second Line :
City : TAOS
State : NM
Zip : 87571-5202
Country : US
Telephone Number : 928-699-8149
Fax Number :
Provider Business Practice Location Address
First Line : 105 BERTHA RD STE B
Second Line :
City : TAOS
State : NM
Zip : 87571-7148
Country : US
Telephone Number : 575-758-4297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2012
Last Update Date : 03/18/2024

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Directions to “ MRS. KATHY ANN THERIOT ” Practice Location

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