Kathleen Forrest, PTA
Individual provider Active NPI Specialist · Wilmington, DE
NPI 1013346030 · NPPES record last updated Nov 12, 2013
Key facts
- NPI
- 1013346030
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- J20000173 (DE)
- Practice address
- 3411 Silverside Rd
Springer BLDG Suite 105
Wilmington, DE 19810-4812 - Phone
- (302) 478-5240
- Fax
- (302) 478-2594
- NPI assigned
- Nov 12, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J20000173 | DE | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | J20000173 | DE | Yes |
Addresses
Primary practice location
3411 Silverside Rd
Springer BLDG Suite 105
Wilmington, DE 19810-4812
Mailing address
413 Cleveland Ave
Newport, DE 19804-3020
Phone (302) 478-5240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G00716 | Medicaid | DE |
Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.