Provider Demographics
NPI:1174331169
Name:PARTIN, KATHLEEN SHAWN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SHAWN
Last Name:PARTIN
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 1:7545 N US HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663-9148
Mailing Address - Country:US
Mailing Address - Phone:231-620-0933
Mailing Address - Fax:
Practice Address - Street 1:7545 N US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663-9148
Practice Address - Country:US
Practice Address - Phone:231-620-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services