Provider Demographics
NPI:1497989297
Name:TOLUBA, KATHERINE CARROLL (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CARROLL
Last Name:TOLUBA
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 1:409 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1619
Mailing Address - Country:US
Mailing Address - Phone:785-456-1785
Mailing Address - Fax:
Practice Address - Street 1:409 ELM ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1619
Practice Address - Country:US
Practice Address - Phone:785-456-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist