Provider Demographics
NPI:1245786326
Name:HARASYMIW, KATHLEEN MCMANUS (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MCMANUS
Last Name:HARASYMIW
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:117 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5725
Practice Address - Country:US
Practice Address - Phone:617-298-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 8781-OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist