Provider Demographics
NPI:1407498421
Name:POLLACK, KATHERINE DOUGLASS (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DOUGLASS
Last Name:POLLACK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 HAVEN RD APT E
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1023
Mailing Address - Country:US
Mailing Address - Phone:860-318-6756
Mailing Address - Fax:
Practice Address - Street 1:2112 HAVEN RD APT E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1023
Practice Address - Country:US
Practice Address - Phone:860-318-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016486225X00000X
DEU1-0012353225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist