Provider Demographics
NPI:1285928861
Name:BAIR, KACIE (EDS/NCSP)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:EDS/NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NELLIGAN TERRACE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01083-0543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 CHARLTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1910
Practice Address - Country:US
Practice Address - Phone:508-765-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist