=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740822113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KC THERAPEUTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2019
-----------------------------------------------------
Last Update Date | 11/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 BRADFORD ST STE E
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-2369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-217-4041
-----------------------------------------------------
Fax | 412-887-3674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 ELMWOOD AVE
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, OTR/L
-----------------------------------------------------
Name | KATHERINE COLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-979-6811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------