Provider Demographics
NPI:1083248231
Name:ISOM, KATELYN GRACE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:GRACE
Last Name:ISOM
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 1:4600 BUSINESS PARK BLVD # D24
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7142
Mailing Address - Country:US
Mailing Address - Phone:907-561-1475
Mailing Address - Fax:888-552-1720
Practice Address - Street 1:4600 BUSINESS PARK BLVD # D24
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7142
Practice Address - Country:US
Practice Address - Phone:907-561-1475
Practice Address - Fax:888-552-1720
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157256225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics