Provider Demographics
NPI:1992596068
Name:GONNEVILLE, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GONNEVILLE
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 1:195 HUNTS MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5941
Mailing Address - Country:US
Mailing Address - Phone:207-446-4664
Mailing Address - Fax:
Practice Address - Street 1:15 HASSON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-1613
Practice Address - Country:US
Practice Address - Phone:207-446-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist