Provider Demographics
NPI:1174975569
Name:SURALIK, KATHRYN (LMBT, NCBTMB)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SURALIK
Suffix:
Gender:F
Credentials:LMBT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4129
Mailing Address - Country:US
Mailing Address - Phone:252-269-1210
Mailing Address - Fax:
Practice Address - Street 1:1111 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4129
Practice Address - Country:US
Practice Address - Phone:252-269-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist