MEDICARE: KATIE PURTEE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881135663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE PURTEE

Provider Business Mailing Address
First Line	:	3550 S. IDDINGS RD.
Second Line	:
City	:	WEST MILTON
State	:	OH
Zip	:	45383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 S IDDINGS RD
Second Line	:
City	:	WEST MILTON
State	:	OH
Zip	:	45383-8702
Country	:	US
Telephone Number	:	937-232-5236
Fax Number	:

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

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	03/14/2017

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Directions to “ KATIE PURTEE ” Practice Location

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