Provider Demographics
NPI:1003258088
Name:RUTKIN, KATHY T
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:T
Last Name:RUTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:TESCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:486 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1386
Mailing Address - Country:US
Mailing Address - Phone:508-765-0292
Mailing Address - Fax:508-765-0294
Practice Address - Street 1:486 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1386
Practice Address - Country:US
Practice Address - Phone:508-765-0292
Practice Address - Fax:508-765-0294
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program