Provider Demographics
NPI:1992909212
Name:RUDD, KATHERINE B (PTA)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:B
Last Name:RUDD
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 1:201 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8456
Mailing Address - Country:US
Mailing Address - Phone:317-877-9077
Mailing Address - Fax:317-241-2535
Practice Address - Street 1:6855 SHORE TER
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4662
Practice Address - Country:US
Practice Address - Phone:317-241-3200
Practice Address - Fax:317-241-2535
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001840A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist