Provider Demographics
NPI: | 1881033041 |
---|---|
Name: | KATHARINE SEYMOUR |
Entity Type: | Organization |
Organization Name: | KATHARINE SEYMOUR |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH-LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KATHARINE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | SEYMOUR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MCD, CCC-SLP |
Authorized Official - Phone: | 404-409-0587 |
Mailing Address - Street 1: | 70 PERIMETER CTR E APT 2334 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30346-1815 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-409-0587 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 70 PERIMETER CTR E APT 2334 |
Practice Address - Street 2: | |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30346-1815 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-409-0587 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-06-21 |
Last Update Date: | 2013-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | SLP007862 | 261QR0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |