Provider Demographics
NPI:1225354079
Name:BAESL, KATHRYN SUE (COTA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:SUE
Last Name:BAESL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 CR NE 2045
Mailing Address - Street 2:
Mailing Address - City:MT .VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457
Mailing Address - Country:US
Mailing Address - Phone:903-537-3244
Mailing Address - Fax:
Practice Address - Street 1:123 PECAN BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1816
Practice Address - Country:US
Practice Address - Phone:903-856-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207459173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine