Provider Demographics
NPI:1396361424
Name:HARRIS, KATELYN ROSE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ROSE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:ROSE
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 E 8TH AVE APT 313
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4538
Mailing Address - Country:US
Mailing Address - Phone:949-939-7405
Mailing Address - Fax:
Practice Address - Street 1:4495 HALE PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6210
Practice Address - Country:US
Practice Address - Phone:844-757-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist