Basic Information
| Provider Information | |||||||||
| NPI: | 1760944045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRADER | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | HAS, BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2046 TREASURE COAST PLZ STE B | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329600930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725647200 | ||||||||
| FaxNumber: | 7725649179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2046 TREASURE COAST PLZ STE B | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329600930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725647200 | ||||||||
| FaxNumber: | 7725649179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS5220 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.