Individual
MR. KGATALE SIKO MALATSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3811 PARNELL AVE, FORT WAYNE, IN 46805-1409
(260) 482-4651
Mailing address
6013 BELLE ISLE LN, FORT WAYNE, IN 46835-1263
(260) 492-6420
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266090
—
IN
Enumeration date
07/03/2007
Last updated
07/08/2007
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