Provider Demographics
NPI:1659839215
Name:ROUSE, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ROUSE
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 1:35 MANAS CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1100
Mailing Address - Country:US
Mailing Address - Phone:678-521-2262
Mailing Address - Fax:
Practice Address - Street 1:35 MANAS CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1100
Practice Address - Country:US
Practice Address - Phone:678-521-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO582201744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management