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General NPI Number Information
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NPI Number | 1700876083
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Entity Type | Organization
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Legal Business Name | KOH, INC.
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 175 NATE WHIPPLE HWY SUITE 201
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City | CUMBERLAND
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State | RI
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Zip | 02864-1416
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Country | US
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Telephone | 401-671-2934
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Fax | 401-671-2936
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Provider Business Mailing Address
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Address Line | 175 NATE WHIPPLE HWY SUITE 201
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City | CUMBERLAND
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State | RI
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Zip | 02864-1416
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Country | US
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Telephone | 401-671-2934
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Fax | 401-671-2936
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | KATE ANN O'HEELAN
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Credential | DO
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Telephone | 401-475-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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