Provider Demographics
NPI:1083498265
Name:PARKER, KATIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PARKER
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 1:4405 MAIDEN FOREST RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MD
Mailing Address - Zip Code:21869-1527
Mailing Address - Country:US
Mailing Address - Phone:443-521-6147
Mailing Address - Fax:
Practice Address - Street 1:2424 NORTHGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7888
Practice Address - Country:US
Practice Address - Phone:410-677-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist