Provider Demographics
NPI:1881017036
Name:BARRON, KATHLEEN VICTORIA (NCTMB, MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VICTORIA
Last Name:BARRON
Suffix:
Gender:F
Credentials:NCTMB, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MONUMENT AVE
Mailing Address - Street 2:SUITE 327
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5762
Mailing Address - Country:US
Mailing Address - Phone:407-361-2523
Mailing Address - Fax:
Practice Address - Street 1:111 E MONUMENT AVE
Practice Address - Street 2:SUITE 327
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5762
Practice Address - Country:US
Practice Address - Phone:407-361-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist