Provider Demographics
NPI:1619373123
Name:KARGES, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KARGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 COACHLITE DR
Mailing Address - Street 2:
Mailing Address - City:WADESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47638-9600
Mailing Address - Country:US
Mailing Address - Phone:812-431-3715
Mailing Address - Fax:
Practice Address - Street 1:811 COACHLITE DR
Practice Address - Street 2:
Practice Address - City:WADESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47638-9600
Practice Address - Country:US
Practice Address - Phone:812-431-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001899A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant