Individual
KATHLEEN N HEADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
830 BROAD ST, SUITE 1, SHREWSBURY, NJ 07702-4215
(732) 758-1800
Mailing address
19 N LAKE DR, MIDDLETOWN, NJ 07748-2315
(610) 283-4152
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
18KT00440300
NJ
Other
Enumeration date
06/26/2015
Last updated
06/26/2015
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