Provider Demographics
NPI:1215965926
Name:BAGNATO, KATHERINE M (ATC, OTC, CEAS)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:BAGNATO
Suffix:
Gender:F
Credentials:ATC, OTC, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 CARNEGIE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4633
Mailing Address - Country:US
Mailing Address - Phone:609-377-7310
Mailing Address - Fax:
Practice Address - Street 1:5825 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4633
Practice Address - Country:US
Practice Address - Phone:609-377-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00056400246Z00000X, 2255A2300X
NCLAT-29242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other