Provider Demographics
NPI:1033245006
Name:O'MALLEY, KATHLEEN J (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:80 WORCESTER ST
Mailing Address - Street 2:SUITE# 2
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1041
Mailing Address - Country:US
Mailing Address - Phone:508-839-0040
Mailing Address - Fax:508-839-0043
Practice Address - Street 1:80 WORCESTER ST
Practice Address - Street 2:SUITE# 2
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1041
Practice Address - Country:US
Practice Address - Phone:508-839-0040
Practice Address - Fax:508-839-0043
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7302717OtherAETNA
MAY36801OtherBLUE CROSS BLUE SHIELD
MA043579486OtherTAX IDENTIFICATION NO.
MA460230OtherTUFTS HEALTH PLAN
MA1696742Medicaid
MAU76112Medicare UPIN
MA1696742Medicaid