Provider Demographics
NPI:1659878163
Name:NILSEN, KATHLEEN (OTR)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NILSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:NILSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:519 WHITEHURST CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1917
Mailing Address - Country:US
Mailing Address - Phone:925-785-4008
Mailing Address - Fax:
Practice Address - Street 1:21630 MERCHANTS WAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2514
Practice Address - Country:US
Practice Address - Phone:832-230-1518
Practice Address - Fax:281-741-7355
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113603225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist