Provider Demographics
NPI:1477703528
Name:MAGILL, KATHRYN VANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:VANN
Last Name:MAGILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SWITZER DR APT 7
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3111
Mailing Address - Country:US
Mailing Address - Phone:706-814-4007
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPIAL AVE
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-4283
Practice Address - Country:US
Practice Address - Phone:706-787-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist