Provider Demographics
NPI:1104854546
Name:KLOPFENSTEIN, MARY KATHARINE (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:KLOPFENSTEIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 KELLEY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5820
Mailing Address - Country:US
Mailing Address - Phone:731-644-0002
Mailing Address - Fax:731-641-0030
Practice Address - Street 1:1015 KELLEY DR STE 101
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5820
Practice Address - Country:US
Practice Address - Phone:731-644-0002
Practice Address - Fax:731-641-0030
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare ID - Type UnspecifiedGROUP