Provider Demographics
NPI:1568452936
Name:LACHANCE, KATHRYN L (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2930
Mailing Address - Country:US
Mailing Address - Phone:603-689-7890
Mailing Address - Fax:
Practice Address - Street 1:16 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2930
Practice Address - Country:US
Practice Address - Phone:603-689-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4457101YM0800X
MECC4829101YM0800X
MEOT491225X00000X
NH2550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
010416156OtherTRAVELERS/CORE/MEDNET
061186OtherANTHEM
626286OtherHARVARD PILGRIM
UX5776OtherACTIVE PROVIDER TRANSACTION ACCESS NUMBER
201017OtherASC FACILITY
0378600001OtherDMERC
ME255260099Medicaid
ME1131OtherPTAN #
MM0716OtherCLINIC FACILITY
4457003OtherGREAT WEST/CIGNA
5710622OtherAETNA
100294000OtherUSPS WC
0378600001OtherDMERC
5710622OtherAETNA