Provider Demographics
NPI:1528506581
Name:WOLFF, KATHLEEN M
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:WOLFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5994 SENECA CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7984
Mailing Address - Country:US
Mailing Address - Phone:315-427-7043
Mailing Address - Fax:
Practice Address - Street 1:5994 SENECA CT
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-7984
Practice Address - Country:US
Practice Address - Phone:315-427-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY447168146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY447168OtherNYS DEPT. OF HEALTH BUREAU OF EMERGENCY MEDICAL SERVICES EMT-BASIC