Provider Demographics
NPI:1164861191
Name:SEELEY, KATIE (MSED)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:
Last Name:SEELEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BLACKMORE RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2102
Mailing Address - Country:US
Mailing Address - Phone:315-395-4497
Mailing Address - Fax:
Practice Address - Street 1:706 S 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4905
Practice Address - Country:US
Practice Address - Phone:315-887-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591254121174400000X
NY575946111174400000X
NY591253121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist