Provider Demographics
NPI:1831248871
Name:BROSSMAN-KURTZ, KATHRYN E (RD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:E
Last Name:BROSSMAN-KURTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2903
Mailing Address - Country:US
Mailing Address - Phone:508-334-6366
Mailing Address - Fax:509-334-6091
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-6366
Practice Address - Fax:508-334-6091
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABR MT0127Medicare PIN