Provider Demographics
NPI:1033595723
Name:ZEITLER, KATHRYN
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:ZEITLER
Suffix:
Gender:F
Credentials:
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 273
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-0273
Mailing Address - Country:US
Mailing Address - Phone:954-804-8920
Mailing Address - Fax:
Practice Address - Street 1:735 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37383-2000
Practice Address - Country:US
Practice Address - Phone:931-598-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL39582255A2300X
TNAT00000018762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
69784OtherNATA
BOC270716OtherATC BOC