Basic Information
Provider Information
NPI: 1003291295
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYLVAIN
FirstName: KATHERINE
MiddleName: ANNE
NamePrefix: MS.
NameSuffix:  
Credential: ATC, LAT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 EASTHAMPTON RD
Address2: APT. A2
City: HOLYOKE
State: MA
PostalCode: 010407303
CountryCode: US
TelephoneNumber: 4133879362
FaxNumber:  
Practice Location
Address1: 577 WESTERN AVE
Address2:  
City: WESTFIELD
State: MA
PostalCode: 010852580
CountryCode: US
TelephoneNumber: 4135728270
FaxNumber: 4135728250
Other Information
ProviderEnumerationDate: 07/29/2015
LastUpdateDate: 07/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2255A2300X2019MAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer

No ID Information.


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