Provider Demographics
NPI:1548533250
Name:WEBB, KATHLEEN A
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLOVE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1626
Mailing Address - Country:US
Mailing Address - Phone:732-230-3434
Mailing Address - Fax:
Practice Address - Street 1:10 CLOVE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1626
Practice Address - Country:US
Practice Address - Phone:732-230-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT152225700000X
NJ26BT00363000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist