Provider Demographics
NPI:1083901292
Name:KLEIN, CATHERINE ANNE
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANNE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 SR 56
Mailing Address - Street 2:PO BOX 302
Mailing Address - City:COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13625-0302
Mailing Address - Country:US
Mailing Address - Phone:315-262-2636
Mailing Address - Fax:
Practice Address - Street 1:4808 ST HYWY 56
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:NY
Practice Address - Zip Code:13625-0302
Practice Address - Country:US
Practice Address - Phone:315-262-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021302-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist