Provider Demographics
NPI:1477826725
Name:MANN, KATHLEEN A (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:MANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAMOSET AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2324
Mailing Address - Country:US
Mailing Address - Phone:617-471-9369
Mailing Address - Fax:
Practice Address - Street 1:11 CONDITO RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1746
Practice Address - Country:US
Practice Address - Phone:781-749-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist