Provider Demographics
NPI:1053502419
Name:CORPUS, KATHLEEN BARNES (OTR/L, CDRS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BARNES
Last Name:CORPUS
Suffix:
Gender:F
Credentials:OTR/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830
Mailing Address - Country:US
Mailing Address - Phone:706-655-5075
Mailing Address - Fax:706-655-5317
Practice Address - Street 1:6135 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830
Practice Address - Country:US
Practice Address - Phone:706-655-5075
Practice Address - Fax:706-655-5317
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist