Provider Demographics
NPI:1467806133
Name:PACHECO, KATLYN E
Entity Type:Individual
Prefix:MS
First Name:KATLYN
Middle Name:E
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 DRIFT RD # D
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-1205
Mailing Address - Country:US
Mailing Address - Phone:774-264-0774
Mailing Address - Fax:
Practice Address - Street 1:581 DRIFT RD # D
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-1205
Practice Address - Country:US
Practice Address - Phone:774-264-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program