Provider Demographics
NPI:1700364296
Name:SICKLES, KATHERINE M (MT-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SICKLES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MCKARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:1669 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1230
Mailing Address - Country:US
Mailing Address - Phone:248-646-3347
Mailing Address - Fax:
Practice Address - Street 1:1669 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-646-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist