Provider Demographics
NPI:1992094445
Name:FURST, NATASHA MARIE (PTA)
Entity type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:MARIE
Last Name:FURST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 UPLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-5535
Mailing Address - Country:US
Mailing Address - Phone:360-936-2850
Mailing Address - Fax:
Practice Address - Street 1:2441 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-5535
Practice Address - Country:US
Practice Address - Phone:360-936-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60067314172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker