Provider Demographics
NPI:1821395906
Name:MOFFETT, KATHRYN M
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100C STATE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9654
Mailing Address - Country:US
Mailing Address - Phone:413-397-8986
Mailing Address - Fax:
Practice Address - Street 1:100C STATE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9654
Practice Address - Country:US
Practice Address - Phone:413-397-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker