Provider Demographics
NPI:1063626810
Name:KELLY-CURTIN, KATHLEEN THERESA (RNBS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESA
Last Name:KELLY-CURTIN
Suffix:
Gender:F
Credentials:RNBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-1635
Mailing Address - Country:US
Mailing Address - Phone:413-243-4573
Mailing Address - Fax:
Practice Address - Street 1:95 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1635
Practice Address - Country:US
Practice Address - Phone:413-243-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704156Medicaid