Provider Demographics
NPI:1710535539
Name:EDDINGS, KATLYN BAGGARLEY (LMBT, AAS)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:BAGGARLEY
Last Name:EDDINGS
Suffix:
Gender:F
Credentials:LMBT, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRIFFIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771
Mailing Address - Country:US
Mailing Address - Phone:912-506-5756
Mailing Address - Fax:
Practice Address - Street 1:51 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771
Practice Address - Country:US
Practice Address - Phone:912-506-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16832225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist