Provider Demographics
NPI:1760437370
Name:DITTO, KATHLEEN E (MA OTR)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:DITTO
Suffix:
Gender:F
Credentials:MA OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 SPOONBILL TRL
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1655
Mailing Address - Country:US
Mailing Address - Phone:904-542-7503
Mailing Address - Fax:904-542-7291
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7503
Practice Address - Fax:904-542-7291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist