Provider Demographics
NPI:1497386452
Name:SURRATT, KADDIE (CPO)
Entity Type:Individual
Prefix:
First Name:KADDIE
Middle Name:
Last Name:SURRATT
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEADOWMONT VILLAGE CIR STE 425
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7505
Mailing Address - Country:US
Mailing Address - Phone:984-974-5783
Mailing Address - Fax:
Practice Address - Street 1:400 MEADOWMONT VILLAGE CIR STE 425
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7505
Practice Address - Country:US
Practice Address - Phone:984-974-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO04500222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty