Provider Demographics
NPI:1205225760
Name:COLEMAN, KATHERINE MARY (MSOT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SOUTHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-5235
Mailing Address - Country:US
Mailing Address - Phone:508-248-6535
Mailing Address - Fax:508-248-7972
Practice Address - Street 1:72 SOUTHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5235
Practice Address - Country:US
Practice Address - Phone:508-248-6535
Practice Address - Fax:508-248-7972
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist