Provider Demographics
NPI:1477062255
Name:DARE, KATRINA (OT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:DARE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SOMERSBY POINTE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7076
Mailing Address - Country:US
Mailing Address - Phone:413-320-8089
Mailing Address - Fax:
Practice Address - Street 1:111 RENEGAR WAY
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-8840
Practice Address - Country:US
Practice Address - Phone:912-291-2032
Practice Address - Fax:912-291-2095
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist