Provider Demographics
NPI:1679616163
Name:BLAND, CATHY MARIE (PRIMARY SERVICE COOR)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:MARIE
Last Name:BLAND
Suffix:
Gender:F
Credentials:PRIMARY SERVICE COOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9954 STATE ROUTE 764
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9701
Mailing Address - Country:US
Mailing Address - Phone:270-233-9552
Mailing Address - Fax:270-233-9588
Practice Address - Street 1:9954 STATE ROUTE 764
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9701
Practice Address - Country:US
Practice Address - Phone:270-233-9552
Practice Address - Fax:270-233-9588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator