MEDICARE: KAYE THERESE SHADDOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	003271-01	NY

General Provider Information

NPI Number	:	1285562421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYE THERESE SHADDOCK

Provider Business Mailing Address
First Line	:	906 MAIN ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2639
Country	:	US
Telephone Number	:	216-650-1527
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 MAIN ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	MA
Zip	:	01267-2639
Country	:	US
Telephone Number	:	216-650-1527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2026
Last Update Date	:	05/09/2026

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Directions to “ KAYE THERESE SHADDOCK ” Practice Location

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