Provider Demographics
NPI:1417735929
Name:FIELD, KATHERINE MARY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:FIELD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3138
Mailing Address - Country:US
Mailing Address - Phone:609-668-3764
Mailing Address - Fax:
Practice Address - Street 1:115 GATEWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4403
Practice Address - Country:US
Practice Address - Phone:570-938-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01144900225X00000X
PAOC019348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist