Provider Demographics
NPI:1366964736
Name:PUCKETT, KATHERINE ANN (BS, SIT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:BS, SIT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:CALABRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:540 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3953
Mailing Address - Country:US
Mailing Address - Phone:208-524-5607
Mailing Address - Fax:208-524-0636
Practice Address - Street 1:540 3RD ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-524-5607
Practice Address - Fax:208-524-0636
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner