Provider Demographics
NPI:1295547677
Name:DANZY, KATELYN A (OTS)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:A
Last Name:DANZY
Suffix:
Gender:F
Credentials:OTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CROW MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2132
Mailing Address - Country:US
Mailing Address - Phone:479-567-4069
Mailing Address - Fax:
Practice Address - Street 1:7006 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6024
Practice Address - Country:US
Practice Address - Phone:479-401-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program