Provider Demographics
NPI:1720683709
Name:FELIX, KATIE M
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:HENDERSHOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9548
Mailing Address - Country:US
Mailing Address - Phone:513-833-7636
Mailing Address - Fax:
Practice Address - Street 1:505 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9548
Practice Address - Country:US
Practice Address - Phone:513-833-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001185175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty