Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT982 | ME |
N | 2251P0200X | Physical Therapist - Pediatrics | PT982 | ME |
NPI | 1083834485 |
---|---|
Provider Name | Ms. Kathleen Ann Kelleher |
First Address | Waterville, ME 04901-4907 |
Second Address | Waterville, ME 04901-4624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT982 | PHYSICAL THERAPY LICENSE (01) | ME |