Provider Demographics
NPI:1760900534
Name:CHILCOTE, KATELYN
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CHILCOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCKHILL FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:17249-7077
Mailing Address - Country:US
Mailing Address - Phone:814-251-4160
Mailing Address - Fax:
Practice Address - Street 1:14500 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6165
Practice Address - Country:US
Practice Address - Phone:408-741-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant