Provider Demographics
NPI:1093945024
Name:INGRAM, KATHERINE MARIE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1231 E WESTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3552
Mailing Address - Country:US
Mailing Address - Phone:585-506-6196
Mailing Address - Fax:
Practice Address - Street 1:1231 E WESTERFIELD PL
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3552
Practice Address - Country:US
Practice Address - Phone:585-506-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist