Provider Demographics
NPI:1659185577
Name:LAW, KATHLEEN PATRICIA (MS, RD, CPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:LAW
Suffix:
Gender:F
Credentials:MS, RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 ATLANTIC ST UNIT 69
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-2045
Mailing Address - Country:US
Mailing Address - Phone:347-733-5691
Mailing Address - Fax:
Practice Address - Street 1:231 ATLANTIC ST UNIT 69
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-2045
Practice Address - Country:US
Practice Address - Phone:347-733-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered