Provider Demographics
NPI:1831334804
Name:NEELS, CATHERINE VIRGINIA
Entity type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:VIRGINIA
Last Name:NEELS
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 1:8019 BANNOCKBURN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5580
Mailing Address - Country:US
Mailing Address - Phone:410-948-5710
Mailing Address - Fax:
Practice Address - Street 1:8019 BANNOCKBURN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5580
Practice Address - Country:US
Practice Address - Phone:410-948-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-1897222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist