Provider Demographics
NPI:1962464537
Name:MOOT, KATHRYN L (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:L
Last Name:MOOT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12928 LISBON ST SE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:44669-9751
Mailing Address - Country:US
Mailing Address - Phone:330-862-2493
Mailing Address - Fax:
Practice Address - Street 1:12928 LISBON STREET SE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:OH
Practice Address - Zip Code:44669-9751
Practice Address - Country:US
Practice Address - Phone:330-862-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20-07-0555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse