Provider Demographics
NPI:1174828974
Name:VAN ZEE, KATIE JO (OT-A)
Entity Type:Individual
Prefix:
First Name:KATIE JO
Middle Name:
Last Name:VAN ZEE
Suffix:
Gender:F
Credentials:OT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57364-2305
Mailing Address - Country:US
Mailing Address - Phone:605-680-4517
Mailing Address - Fax:
Practice Address - Street 1:363 MCKNIGHT AVE.
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-0419
Practice Address - Country:US
Practice Address - Phone:479-839-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A635224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant