Provider Demographics
NPI:1942319553
Name:FOUST, KATHY SUE (BOC CMF)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SUE
Last Name:FOUST
Suffix:
Gender:F
Credentials:BOC CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 OWEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-323-9016
Mailing Address - Fax:910-486-8712
Practice Address - Street 1:234 OWEN DRIVE
Practice Address - Street 2:TOTAL REHAB ORTHOTICS & PROSTHETICS INC
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-9016
Practice Address - Fax:910-486-8712
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795109Medicaid
NC0478VOtherBCBS
NC7795109Medicaid