Healthcare Provider Details

I. General information

NPI: 1306142005
Provider Name (Legal Business Name): KATHLEEN MARIE DREBICK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 EDGEWOOD AVE
WESTVILLE NJ
08093
US

IV. Provider business mailing address

P.O. BOX 5264
DEPTFORD NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 856-465-1020
  • Fax: 856-349-2067
Mailing address:
  • Phone: 856-465-1020
  • Fax: 856-349-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26BT00234800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: