Provider Demographics
NPI:1497208078
Name:SHATLEY, KATHRYN DANIELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DANIELLE
Last Name:SHATLEY
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 1:107 SUMMER LEIGH CV
Mailing Address - Street 2:
Mailing Address - City:BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72411-9462
Mailing Address - Country:US
Mailing Address - Phone:870-219-2138
Mailing Address - Fax:
Practice Address - Street 1:204 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1100
Practice Address - Country:US
Practice Address - Phone:870-219-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1106224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant