Provider Demographics
NPI:1255595419
Name:DILLON, KATHLEEN LAURI (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LAURI
Last Name:DILLON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:124 HERMOSA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2610
Mailing Address - Country:US
Mailing Address - Phone:505-410-3741
Mailing Address - Fax:505-508-1691
Practice Address - Street 1:124 HERMOSA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2610
Practice Address - Country:US
Practice Address - Phone:505-410-3741
Practice Address - Fax:505-508-1691
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist