Basic Information
| Provider Information | |||||||||
| NPI: | 1225354079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAESL | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.O.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 449 CR NE 2045 | ||||||||
| Address2: | |||||||||
| City: | MT .VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035373244 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 123 PECAN BLVD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756861816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038563633 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 04/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 207459 | TX | Y | Other Service Providers | Legal Medicine |
No ID Information.