Provider Demographics
NPI:1447595467
Name:WOLFF, KTRINA KAE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KTRINA
Middle Name:KAE
Last Name:WOLFF
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 1:1905 BRIAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9677
Mailing Address - Country:US
Mailing Address - Phone:336-500-7165
Mailing Address - Fax:
Practice Address - Street 1:1905 BRIAR RUN DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9677
Practice Address - Country:US
Practice Address - Phone:336-500-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6251224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant