Provider Demographics
NPI:1962034413
Name:SPELLMAN, KATIE TAYLOR
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:TAYLOR
Last Name:SPELLMAN
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 1:1227 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0012
Mailing Address - Country:US
Mailing Address - Phone:319-273-2311
Mailing Address - Fax:
Practice Address - Street 1:1227 W 27TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0012
Practice Address - Country:US
Practice Address - Phone:319-273-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program