Provider Demographics
NPI:1003274184
Name:MALCHOW, KATHLEEN (OTR/EDM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MALCHOW
Suffix:
Gender:F
Credentials:OTR/EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 CONCORD HUNT CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8762
Mailing Address - Country:US
Mailing Address - Phone:615-545-4940
Mailing Address - Fax:
Practice Address - Street 1:9137 CONCORD HUNT CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8762
Practice Address - Country:US
Practice Address - Phone:615-545-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4130172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker