Provider Demographics
NPI:1326212879
Name:CARON, KATHLEEN L (MSPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:CARON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:ST. PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 LORELIE DR
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4279
Mailing Address - Country:US
Mailing Address - Phone:207-520-0452
Mailing Address - Fax:
Practice Address - Street 1:690 MINOT AVE STE 1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3968
Practice Address - Country:US
Practice Address - Phone:207-783-3450
Practice Address - Fax:207-777-3979
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist