Provider Demographics
NPI:1831357243
Name:SELTZER, KATHY JOY (LICAC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JOY
Last Name:SELTZER
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 BEACON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2872
Mailing Address - Country:US
Mailing Address - Phone:617-232-0753
Mailing Address - Fax:
Practice Address - Street 1:1368 BEACON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2872
Practice Address - Country:US
Practice Address - Phone:617-232-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA354171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist