Provider Demographics
NPI:1619311826
Name:KANE, KATHLEEN JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JEAN
Last Name:KANE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1606
Mailing Address - Country:US
Mailing Address - Phone:775-824-0110
Mailing Address - Fax:
Practice Address - Street 1:626 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1606
Practice Address - Country:US
Practice Address - Phone:775-824-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1585225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist