Provider Demographics
NPI:1982994612
Name:CALDWELL, KATHERINE ROSS
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSS
Last Name:CALDWELL
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 1:765 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2325
Mailing Address - Country:US
Mailing Address - Phone:910-738-6071
Mailing Address - Fax:910-738-3002
Practice Address - Street 1:765 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2325
Practice Address - Country:US
Practice Address - Phone:910-738-6071
Practice Address - Fax:910-738-3002
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner