Provider Demographics
NPI:1023201696
Name:MAULDIN, KATHERINE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-0151
Mailing Address - Country:US
Mailing Address - Phone:386-559-4068
Mailing Address - Fax:
Practice Address - Street 1:413 ELM ST
Practice Address - Street 2:
Practice Address - City:WELAKA
Practice Address - State:FL
Practice Address - Zip Code:32193
Practice Address - Country:US
Practice Address - Phone:386-559-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist