Provider Demographics
NPI:1033687082
Name:GILSTRAP, KATIE AMANDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:AMANDA
Last Name:GILSTRAP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROCKMONT RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9640
Mailing Address - Country:US
Mailing Address - Phone:843-245-4199
Mailing Address - Fax:
Practice Address - Street 1:110 WILLOW PL APT 324
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-4111
Practice Address - Country:US
Practice Address - Phone:864-855-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist