Provider Demographics
NPI:1154859593
Name:EAKES, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:EAKES
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 1:915 E DRAKE RD APT 192
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1880
Mailing Address - Country:US
Mailing Address - Phone:620-655-1970
Mailing Address - Fax:
Practice Address - Street 1:915 E DRAKE RD APT 192
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1880
Practice Address - Country:US
Practice Address - Phone:620-655-1970
Practice Address - Fax:620-655-1970
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty