Provider Demographics
NPI:1073760823
Name:OSTNEBERG, KATE ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:ELIZABETH
Last Name:OSTNEBERG
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 1:1400 BANANA RD LOT 126
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2056
Mailing Address - Country:US
Mailing Address - Phone:863-450-4825
Mailing Address - Fax:
Practice Address - Street 1:5615 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3107
Practice Address - Country:US
Practice Address - Phone:863-815-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist