Provider Demographics
NPI:1881048098
Name:BLAKEY, KATHY (MED, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:VANDIVER
Mailing Address - State:AL
Mailing Address - Zip Code:35176-7210
Mailing Address - Country:US
Mailing Address - Phone:205-672-9570
Mailing Address - Fax:
Practice Address - Street 1:534 HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:VANDIVER
Practice Address - State:AL
Practice Address - Zip Code:35176-7210
Practice Address - Country:US
Practice Address - Phone:205-672-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer