Provider Demographics
NPI:1376002196
Name:MASON, KATHERINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 N LAKEVIEW DR APT 3915
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1384
Mailing Address - Country:US
Mailing Address - Phone:240-446-8120
Mailing Address - Fax:
Practice Address - Street 1:15002 HUTCHISON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5509
Practice Address - Country:US
Practice Address - Phone:813-960-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant