Provider Demographics
NPI:1598223513
Name:VARNER, KATHRYN GRACE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:VARNER
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 1:711 DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-6880
Mailing Address - Country:US
Mailing Address - Phone:570-994-5162
Mailing Address - Fax:
Practice Address - Street 1:8030 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0335
Practice Address - Country:US
Practice Address - Phone:619-567-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16707225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist