Provider Demographics
NPI:1205018645
Name:WING, KATHLEEN MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:WING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:OBENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 CLEARVIEW PL
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6769
Mailing Address - Country:US
Mailing Address - Phone:406-756-8106
Mailing Address - Fax:
Practice Address - Street 1:135 CLEARVIEW PL
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6769
Practice Address - Country:US
Practice Address - Phone:406-756-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist