Healthcare Provider Details

I. General information

NPI: 1467630426
Provider Name (Legal Business Name): MRS. KATHLEEN ANN WHELIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 STAGE RD
CUMMINGTON MA
01026-9649
US

IV. Provider business mailing address

437 STAGE RD
CUMMINGTON MA
01026-9649
US

V. Phone/Fax

Practice location:
  • Phone: 413-634-5611
  • Fax:
Mailing address:
  • Phone: 413-634-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number280645
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: