Provider Demographics
NPI:1598002701
Name:OSBORNE-DAVIS, KATHLEEN DIANE (ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DIANE
Last Name:OSBORNE-DAVIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:DIANE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:5924 HAGERSTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3913
Mailing Address - Country:US
Mailing Address - Phone:225-751-4592
Mailing Address - Fax:225-755-3291
Practice Address - Street 1:5924 HAGERSTOWN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3913
Practice Address - Country:US
Practice Address - Phone:225-751-4592
Practice Address - Fax:225-755-3291
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA812250OtherATHLETIC TRAINER