Provider Demographics
NPI:1710318985
Name:DAVIS, KATHERINE JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JO
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:336 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-269-2224
Mailing Address - Fax:814-269-4587
Practice Address - Street 1:290 JAMESWAY RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4207
Practice Address - Country:US
Practice Address - Phone:814-472-4921
Practice Address - Fax:814-472-4950
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007299L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist