Provider Demographics
NPI:1093136129
Name:WHELAN, CATHERINE (LMT, CSTD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:LMT, CSTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RUSHLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1035
Mailing Address - Country:US
Mailing Address - Phone:262-623-0758
Mailing Address - Fax:
Practice Address - Street 1:170 JENNIFER RD STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7909
Practice Address - Country:US
Practice Address - Phone:262-623-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4132225700000X
MDM055859225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist