Provider Demographics
NPI:1972655884
Name:BEAULIEU, KATHLEEN KITTILA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KITTILA
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ELMA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-8524
Mailing Address - Country:US
Mailing Address - Phone:302-456-1791
Mailing Address - Fax:
Practice Address - Street 1:5114 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2021
Practice Address - Country:US
Practice Address - Phone:410-649-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer