Provider Demographics
NPI:1689622474
Name:VILLACRES, KATHLEEN A (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:VILLACRES
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 GEMINI PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6110
Mailing Address - Country:US
Mailing Address - Phone:614-262-0907
Mailing Address - Fax:614-262-5269
Practice Address - Street 1:1210 GEMINI PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6110
Practice Address - Country:US
Practice Address - Phone:614-262-0907
Practice Address - Fax:614-262-5269
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 003783225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4118571Medicare ID - Type Unspecified