Healthcare Provider Details

I. General information

NPI: 1619312667
Provider Name (Legal Business Name): KATHERINE L CHELOTTI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE L KIRSHE DPT

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MECHANIC ST
FOXBORO MA
02035-2012
US

IV. Provider business mailing address

535 S MAIN ST
RANDOLPH MA
02368-5261
US

V. Phone/Fax

Practice location:
  • Phone: 508-203-9350
  • Fax: 508-203-9355
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-767-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: