Provider Demographics
NPI:1518052703
Name:LANDERS, CATHERINE (SPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4424
Mailing Address - Country:US
Mailing Address - Phone:770-361-4124
Mailing Address - Fax:770-445-3073
Practice Address - Street 1:262 LAKEVIEW LN
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4424
Practice Address - Country:US
Practice Address - Phone:770-361-4124
Practice Address - Fax:770-445-3073
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006082225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner