Provider Demographics
NPI:1861558975
Name:FAIRBEND, KATHRYN HELEN (MS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HELEN
Last Name:FAIRBEND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2323
Mailing Address - Country:US
Mailing Address - Phone:781-899-6289
Mailing Address - Fax:781-736-1983
Practice Address - Street 1:123 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2323
Practice Address - Country:US
Practice Address - Phone:781-899-6289
Practice Address - Fax:781-736-1983
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist