Provider Demographics
NPI:1295216539
Name:HUMPHREY, KATHERINE CHRISTIAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CHRISTIAN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5024 S 80TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2713
Mailing Address - Country:US
Mailing Address - Phone:402-332-6669
Mailing Address - Fax:
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4199
Practice Address - Country:US
Practice Address - Phone:402-354-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083928225X00000X
NE2070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist