Provider Demographics
NPI:1932649795
Name:KATT, GRACE ELLA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLA
Last Name:KATT
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 1:502 LAGRANGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1895
Mailing Address - Country:US
Mailing Address - Phone:269-921-8971
Mailing Address - Fax:
Practice Address - Street 1:502 LAGRANGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-1895
Practice Address - Country:US
Practice Address - Phone:269-921-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer