Provider Demographics
NPI:1255495172
Name:CHABOT, KATHLEEN BRENDAN (MA TEACHER CERTIFICA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BRENDAN
Last Name:CHABOT
Suffix:
Gender:F
Credentials:MA TEACHER CERTIFICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK AVE
Mailing Address - Street 2:APT D
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-455-2852
Mailing Address - Fax:
Practice Address - Street 1:25 FOREST ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2407
Practice Address - Country:US
Practice Address - Phone:508-226-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program