Provider Demographics
NPI:1023613171
Name:THOMAS, KATHRYN A
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:DISTENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ELDERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1765
Mailing Address - Country:US
Mailing Address - Phone:585-425-9663
Mailing Address - Fax:585-730-4592
Practice Address - Street 1:100 ELDERWOOD CT
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1765
Practice Address - Country:US
Practice Address - Phone:585-425-9663
Practice Address - Fax:585-388-8632
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator