Provider Demographics
NPI:1144804923
Name:SOUZA, KATELYN (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 PECKHAM RD
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:96 PECKHAM RD
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-1713
Practice Address - Country:US
Practice Address - Phone:774-328-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist