Provider Demographics
NPI:1083075048
Name:LARKIN, KANAE (LMT)
Entity Type:Individual
Prefix:
First Name:KANAE
Middle Name:
Last Name:LARKIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PULIS AVE TRLR 35
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2969
Mailing Address - Country:US
Mailing Address - Phone:201-485-7418
Mailing Address - Fax:
Practice Address - Street 1:600 PULIS AVE TRLR 35
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2969
Practice Address - Country:US
Practice Address - Phone:201-485-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00700100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist