Provider Demographics
NPI:1356369342
Name:MUIR, KATHERINE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:MUIR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 VICKROY TERRACE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5230
Mailing Address - Country:US
Mailing Address - Phone:407-671-1135
Mailing Address - Fax:
Practice Address - Street 1:730 COURTLAND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1316
Practice Address - Country:US
Practice Address - Phone:407-975-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4197Medicare ID - Type Unspecified