Provider Demographics
NPI:1891131454
Name:NYE, KATHERINE HALL
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HALL
Last Name:NYE
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 1:60 COFFIN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDIKE
Mailing Address - State:ME
Mailing Address - Zip Code:04986-3524
Mailing Address - Country:US
Mailing Address - Phone:207-629-7558
Mailing Address - Fax:
Practice Address - Street 1:60 COFFIN RD
Practice Address - Street 2:
Practice Address - City:THORNDIKE
Practice Address - State:ME
Practice Address - Zip Code:04986-3524
Practice Address - Country:US
Practice Address - Phone:207-629-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2672224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant