Provider Demographics
NPI:1932643863
Name:MORIN, KATHRYN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MORIN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HARMONY TRL
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1432
Mailing Address - Country:US
Mailing Address - Phone:508-282-9126
Mailing Address - Fax:
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:BROCKTON HOSPITAL, DIETITIANS OFFICE
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered