Provider Demographics
NPI:1033578349
Name:DETWILER, KATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DETWILER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:DETWILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:825 LIVE OAK AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4968
Mailing Address - Country:US
Mailing Address - Phone:330-998-3473
Mailing Address - Fax:
Practice Address - Street 1:826 N WINCHESTER BLVD
Practice Address - Street 2:2G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1313
Practice Address - Country:US
Practice Address - Phone:408-337-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist