Provider Demographics
NPI:1629428073
Name:KENT, KATY AMORELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:AMORELLE
Last Name:KENT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2285 BENTON RD.
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2285 BENTON RD.
Practice Address - Street 2:SUITE C-200
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:870-904-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301663225XP0200X
AROTR2705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2445243Medicaid