Provider Demographics
NPI:1497097836
Name:DEMASS, KATHRYN CLARK (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CLARK
Last Name:DEMASS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LAUREN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/:
Mailing Address - Street 1:405 RACETRACK RD NE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 RACETRACK RD NE STE 101
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3960
Practice Address - Country:US
Practice Address - Phone:850-863-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist