Provider Demographics
NPI:1710558614
Name:COSTNER, KATELYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:COSTNER
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 1:5744 SE PINEHURST TRL
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-1103
Mailing Address - Country:US
Mailing Address - Phone:336-681-8636
Mailing Address - Fax:
Practice Address - Street 1:1401 FORUM WAY STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2324
Practice Address - Country:US
Practice Address - Phone:561-214-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist