Provider Demographics
NPI:1790403293
Name:ONEACRE, KATIE ALEXIS
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ALEXIS
Last Name:ONEACRE
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 1:1413 SOUTHERN GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-3834
Mailing Address - Country:US
Mailing Address - Phone:317-903-1875
Mailing Address - Fax:
Practice Address - Street 1:1413 SOUTHERN GARDENS DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3834
Practice Address - Country:US
Practice Address - Phone:317-903-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer