Provider Demographics
NPI:1376874933
Name:HENRY, KATHERINE DONOVAN (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DONOVAN
Last Name:HENRY
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BENJAMIN LANDING LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3215
Mailing Address - Country:US
Mailing Address - Phone:508-298-9505
Mailing Address - Fax:
Practice Address - Street 1:15 BENJAMIN LANDING LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3215
Practice Address - Country:US
Practice Address - Phone:508-298-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006132255A2300X
MA18692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer