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General NPI Number Information
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NPI Number | 1013346030
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Entity Type | Individual
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Provider Name | KATHLEEN FORREST PTA
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Gender | Female
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 3411 SILVERSIDE RD SPRINGER BLDG SUITE 105
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City | WILMINGTON
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State | DE
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Zip | 19810-4812
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Country | US
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Telephone | 302-478-5240
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Fax | 302-478-2594
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Provider Business Mailing Address
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Address Line | 413 CLEVELAND AVE
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City | NEWPORT
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State | DE
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Zip | 19804-3020
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Country | US
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Telephone | 302-478-5240
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Fax | 302-478-2594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J20000173
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License Number State | DE
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