Provider Demographics
NPI:1720203888
Name:WHITE, KATHRYN E (LICENSE MASSAGE THER)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICENSE MASSAGE THER
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSE MASSAGE THER
Mailing Address - Street 1:346 LORENZO PLACE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-733-5013
Mailing Address - Fax:
Practice Address - Street 1:460 EAST CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-733-3235
Practice Address - Fax:607-733-4036
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0120241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist