Provider Demographics
NPI:1871960518
Name:DECARLO, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DECARLO
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 1:176 EDDIE DOWLING HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-8233
Mailing Address - Country:US
Mailing Address - Phone:401-597-5665
Mailing Address - Fax:401-597-5667
Practice Address - Street 1:176 EDDIE DOWLING HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8233
Practice Address - Country:US
Practice Address - Phone:401-597-5665
Practice Address - Fax:401-597-5667
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist