Provider Demographics
NPI:1518604792
Name:TATE, KALIE (OTR)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 WOLF CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2353
Mailing Address - Country:US
Mailing Address - Phone:337-508-2505
Mailing Address - Fax:337-508-2506
Practice Address - Street 1:1714 WOLF CIR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2353
Practice Address - Country:US
Practice Address - Phone:337-508-2505
Practice Address - Fax:337-508-2506
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist