Healthcare Provider Details

I. General information

NPI: 1841579042
Provider Name (Legal Business Name): KATE CONNOR LMT, AE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HORTON PL SUITE 101
TOPSHAM ME
04086-1747
US

IV. Provider business mailing address

4 HORTON PL SUITE 101
TOPSHAM ME
04086-1747
US

V. Phone/Fax

Practice location:
  • Phone: 207-798-6275
  • Fax: 207-798-6290
Mailing address:
  • Phone: 207-798-6275
  • Fax: 207-798-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2560
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: