Individual
KATHRYN MOTTAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 MANTON AVE, PROVIDENCE, RI 02909-5633
(401) 274-6310
Mailing address
106 MARTHA ST, PAWTUCKET, RI 02860-1515
(401) 524-6808
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
ISW02521
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05036938
—
RI
Enumeration date
01/12/2016
Last updated
01/12/2016
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