Provider Demographics
NPI:1598325193
Name:RUSH, KATRINA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:HOLVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1287
Mailing Address - Country:US
Mailing Address - Phone:631-553-2846
Mailing Address - Fax:
Practice Address - Street 1:625 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8642
Practice Address - Country:US
Practice Address - Phone:307-739-7458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1333225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology