Provider Demographics
NPI:1164574042
Name:BARTLETT, KATHLEEN ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 FOREST AVE
Mailing Address - Street 2:#14
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1161
Mailing Address - Country:US
Mailing Address - Phone:207-219-0848
Mailing Address - Fax:
Practice Address - Street 1:7 OAK HILL TER
Practice Address - Street 2:SUITE 3
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8996
Practice Address - Country:US
Practice Address - Phone:207-219-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC406171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist