Provider Demographics
NPI:1518326289
Name:WOLFE, KATE (LMT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SMUKLER
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1001 MASSACHUSETTS AVE
Mailing Address - Street 2:O2 YOGA STUDIO
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5327
Mailing Address - Country:US
Mailing Address - Phone:617-505-1454
Mailing Address - Fax:
Practice Address - Street 1:1001 MASSACHUSETTS AVE
Practice Address - Street 2:O2 YOGA STUDIO
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5327
Practice Address - Country:US
Practice Address - Phone:617-505-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist