Provider Demographics
NPI:1770622375
Name:DUBOSE, KATHLEEN MARIE (CMT, CIIM,CA)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:CMT, CIIM,CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SHADY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8795
Mailing Address - Country:US
Mailing Address - Phone:209-544-0549
Mailing Address - Fax:209-577-3103
Practice Address - Street 1:1901 STANDIFORD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0149
Practice Address - Country:US
Practice Address - Phone:209-324-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE 0090497OtherINSTRUCTOR TRAINING
CA397085-00OtherNCBTMB
CACMTOtherTOUCHING FOR HEALTH
CA795230OtherABMP
CACE40HOURSOtherAROMTHERAPY ESSENTIALS
CA492759 YLEOOtherINDEPENDENT DISTRIBUTOR
CACE 12HOURSOtherCHAIR MASSAGE
CACIIMOtherINSTRUCTOR CERTIFICATION