Provider Demographics
NPI:1073877312
Name:BROTEN, KATHY M (MS)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:M
Last Name:BROTEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 STATE HIGHWAY 205
Mailing Address - Street 2:
Mailing Address - City:HARTWICK
Mailing Address - State:NY
Mailing Address - Zip Code:13348-2005
Mailing Address - Country:US
Mailing Address - Phone:607-293-6133
Mailing Address - Fax:
Practice Address - Street 1:3559 STATE HIGHWAY 205
Practice Address - Street 2:
Practice Address - City:HARTWICK
Practice Address - State:NY
Practice Address - Zip Code:13348-2005
Practice Address - Country:US
Practice Address - Phone:607-293-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1413891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist