Provider Demographics
NPI:1114267846
Name:TABER, KATHLEEN M (MED, ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:TABER
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:CAHALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, ATC
Mailing Address - Street 1:600 HENNEPIN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1816
Mailing Address - Country:US
Mailing Address - Phone:612-750-3524
Mailing Address - Fax:
Practice Address - Street 1:600 HENNEPIN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1816
Practice Address - Country:US
Practice Address - Phone:612-750-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer