Provider Demographics
NPI:1568764165
Name:FOX, KATHLEEN (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 GREENVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20689-9547
Mailing Address - Country:US
Mailing Address - Phone:410-271-7319
Mailing Address - Fax:877-384-9028
Practice Address - Street 1:14201 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2866
Practice Address - Country:US
Practice Address - Phone:301-952-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist