Provider Demographics
NPI:1295928695
Name:PETTY, KATHRYN MARIE-TITHOF (ATC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE-TITHOF
Last Name:PETTY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:722 PINEGATE DR
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-8972
Mailing Address - Country:US
Mailing Address - Phone:517-304-4693
Mailing Address - Fax:
Practice Address - Street 1:309 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:WEBBERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48892-8602
Practice Address - Country:US
Practice Address - Phone:517-521-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer