Provider Demographics
NPI:1700361656
Name:EDGAR, KATHERINE LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEIGH
Last Name:EDGAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RIVERFRONT DR APT 165
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5687
Mailing Address - Country:US
Mailing Address - Phone:860-803-3256
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE H10
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2284
Practice Address - Country:US
Practice Address - Phone:501-547-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3163225X00000X
TN6712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist