Provider Demographics
NPI:1639357551
Name:PETERS, MARY KATE (MED)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MILLER TER
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1326
Mailing Address - Country:US
Mailing Address - Phone:508-386-3626
Mailing Address - Fax:
Practice Address - Street 1:15 MILLER TER
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1326
Practice Address - Country:US
Practice Address - Phone:508-386-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant