Provider Demographics
NPI:1396567137
Name:RICHARDS-ALLEN, KATHLEEN (LMT, NTP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RICHARDS-ALLEN
Suffix:
Gender:F
Credentials:LMT, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31253 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055-9082
Mailing Address - Country:US
Mailing Address - Phone:269-251-3557
Mailing Address - Fax:
Practice Address - Street 1:31253 BASELINE RD
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-9082
Practice Address - Country:US
Practice Address - Phone:269-251-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist