Provider Demographics
NPI:1720651763
Name:PARKER, KATIE J (MT-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2105
Mailing Address - Country:US
Mailing Address - Phone:508-405-6412
Mailing Address - Fax:
Practice Address - Street 1:100 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1804
Practice Address - Country:US
Practice Address - Phone:508-860-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-09-27
Deactivation Date:2021-08-27
Deactivation Code:
Reactivation Date:2021-09-23
Provider Licenses
StateLicense IDTaxonomies
MA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist