Provider Demographics
NPI:1790288520
Name:BARTHOLOMEW, KATI OREA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATI
Middle Name:OREA
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATI
Other - Middle Name:OREA
Other - Last Name:KLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-4921
Mailing Address - Country:US
Mailing Address - Phone:715-808-4405
Mailing Address - Fax:
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7299
Practice Address - Fax:508-941-6299
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant