Provider Demographics
NPI:1760869903
Name:FATHERS, KATHRYN ANNE (MA, MT-BC, LCAT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:FATHERS
Suffix:
Gender:F
Credentials:MA, MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3045
Mailing Address - Country:US
Mailing Address - Phone:315-751-3096
Mailing Address - Fax:
Practice Address - Street 1:111 CIRCLE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3045
Practice Address - Country:US
Practice Address - Phone:315-751-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11553225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001816OtherLICENSED CREATIVE ARTS THERAPIST
11553OtherMT-BC MUSIC THERAPY NATIONAL BOARD CERTIFICATION