Provider Demographics
NPI:1043739386
Name:WELSH, KATHERINE LYNNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNNE
Last Name:WELSH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14818 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:CRESAPTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5551
Mailing Address - Country:US
Mailing Address - Phone:304-790-1679
Mailing Address - Fax:
Practice Address - Street 1:1 DIANE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719
Practice Address - Country:US
Practice Address - Phone:304-298-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2107224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant