Provider Demographics
NPI:1063961464
Name:MALLET, KATHERINE JESSIEANNE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JESSIEANNE
Last Name:MALLET
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 1:2400 NUECES ST
Mailing Address - Street 2:APT. 1009B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4811
Mailing Address - Country:US
Mailing Address - Phone:281-615-9070
Mailing Address - Fax:
Practice Address - Street 1:2400 NUECES ST
Practice Address - Street 2:APT. 1009B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4811
Practice Address - Country:US
Practice Address - Phone:281-615-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer