Provider Demographics
NPI:1265874564
Name:HADDOCK, KATHERINE LAGUENS (ATC/L, OTC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LAGUENS
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:ATC/L, OTC
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:LAGUENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC/L, OTC
Mailing Address - Street 1:1040 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7809
Mailing Address - Country:US
Mailing Address - Phone:850-916-8782
Mailing Address - Fax:850-916-8458
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-8782
Practice Address - Fax:850-916-8458
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL27662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer