Provider Demographics
NPI:1326662529
Name:WINDHAM, KATABRA
Entity Type:Individual
Prefix:
First Name:KATABRA
Middle Name:
Last Name:WINDHAM
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 1:4090 E 176TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2226
Mailing Address - Country:US
Mailing Address - Phone:216-755-9630
Mailing Address - Fax:
Practice Address - Street 1:4090 E 176TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2226
Practice Address - Country:US
Practice Address - Phone:216-755-9630
Practice Address - Fax:216-755-7851
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health