Provider Demographics
NPI:1972201614
Name:BECKER, KATHLEEN DALTON
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DALTON
Last Name:BECKER
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 1:4803 RACHELLE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6716
Mailing Address - Country:US
Mailing Address - Phone:832-370-7530
Mailing Address - Fax:
Practice Address - Street 1:4803 RACHELLE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6716
Practice Address - Country:US
Practice Address - Phone:832-370-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program