Provider Demographics
NPI:1265096192
Name:DEWITT, NATALEIGH R
Entity type:Individual
Prefix:
First Name:NATALEIGH
Middle Name:R
Last Name:DEWITT
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 1:421 KOHLER CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5113
Mailing Address - Country:US
Mailing Address - Phone:707-480-3381
Mailing Address - Fax:256-377-6985
Practice Address - Street 1:421 KOHLER CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5113
Practice Address - Country:US
Practice Address - Phone:707-480-3381
Practice Address - Fax:256-377-6985
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist