Provider Demographics
NPI:1285212779
Name:WOODARD, KATIE LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23809 THACH RD
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-3825
Mailing Address - Country:US
Mailing Address - Phone:256-497-1311
Mailing Address - Fax:
Practice Address - Street 1:8075 MADISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2042
Practice Address - Country:US
Practice Address - Phone:256-270-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6272225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist