Healthcare Provider Details

I. General information

NPI: 1285562421
Provider Name (Legal Business Name): KAYE THERESE SHADDOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAIN ST
WILLIAMSTOWN MA
01267-2639
US

IV. Provider business mailing address

906 MAIN ST
WILLIAMSTOWN MA
01267-2639
US

V. Phone/Fax

Practice location:
  • Phone: 216-650-1527
  • Fax:
Mailing address:
  • Phone: 216-650-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number003271-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: