Provider Demographics
NPI:1144962515
Name:LETTERMAN, KATHY D (LMT-NJ, BCTMB)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:LETTERMAN
Suffix:
Gender:F
Credentials:LMT-NJ, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601A OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4538
Mailing Address - Country:US
Mailing Address - Phone:908-359-5777
Mailing Address - Fax:
Practice Address - Street 1:601A OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4538
Practice Address - Country:US
Practice Address - Phone:908-359-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00069500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000510OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK
NJ18KT00069500OtherMASSAGE LICENSE ISSUED BY NJ BOARD OF MASSAGE AND BODYWORK THERAPY