Provider Demographics
NPI:1295138295
Name:KATZENMOYER, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KATZENMOYER
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 1:500 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9500
Mailing Address - Country:US
Mailing Address - Phone:484-671-3039
Mailing Address - Fax:484-671-2913
Practice Address - Street 1:500 ELM ST
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-9500
Practice Address - Country:US
Practice Address - Phone:484-671-3039
Practice Address - Fax:484-671-2913
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA26323601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care