Provider Demographics
NPI:1548082837
Name:STARR, KATHLEEN FAYE (LMT #10005-146)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FAYE
Last Name:STARR
Suffix:
Gender:F
Credentials:LMT #10005-146
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2241
Mailing Address - Country:US
Mailing Address - Phone:608-475-1021
Mailing Address - Fax:
Practice Address - Street 1:186 E MILL ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2241
Practice Address - Country:US
Practice Address - Phone:608-475-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10005-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist