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General NPI Number Information
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NPI Number | 1386040566
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Entity Type | Individual
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Provider Name | KATHLEEN SHAW
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Gender | Female
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 795 WASHINGTON RD
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City | RYE
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State | NH
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Zip | 03870-2318
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Country | US
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Telephone | 603-379-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 16 CHRISTIE LN
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City | STRATHAM
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State | NH
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Zip | 03885-2484
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Country | US
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Telephone |
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Fax |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1998
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License Number State | NH
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