Provider Demographics
NPI:1699225896
Name:PABST, KATILYN BROOKE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KATILYN
Middle Name:BROOKE
Last Name:PABST
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATILYN
Other - Middle Name:BROOKE
Other - Last Name:ELROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1100 CLUB VILLAGE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4409
Mailing Address - Country:US
Mailing Address - Phone:573-256-2777
Mailing Address - Fax:
Practice Address - Street 1:1100 CLUB VILLAGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4409
Practice Address - Country:US
Practice Address - Phone:573-256-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant