Healthcare Provider Details

I. General information

NPI: 1063671097
Provider Name (Legal Business Name): KATHRYN TIMM SHERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BREMEN RD
WALDOBORO ME
04572
US

IV. Provider business mailing address

PO BOX 625
WALDOBORO ME
04572-0625
US

V. Phone/Fax

Practice location:
  • Phone: 207-832-6347
  • Fax: 207-832-4664
Mailing address:
  • Phone: 207-832-6347
  • Fax: 207-832-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1666
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: