Provider Demographics
NPI:1689096638
Name:FUNK, KATIE J (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:FUNK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:J
Other - Last Name:WEDEKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 PRAIRIE PKWY
Mailing Address - Street 2:ST 104
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-222-2901
Mailing Address - Fax:319-222-2991
Practice Address - Street 1:5100 PRAIRIE PKWY
Practice Address - Street 2:ST 104
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-222-2901
Practice Address - Fax:319-222-2991
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist