Provider Demographics
NPI:1093174609
Name:KING, KATHRYN (MS, CCLS, CIMI)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCLS, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CHARD ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1658
Mailing Address - Country:US
Mailing Address - Phone:617-306-7708
Mailing Address - Fax:
Practice Address - Street 1:144 CHARD ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1658
Practice Address - Country:US
Practice Address - Phone:617-306-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist