Provider Demographics
NPI:1790191146
Name:FREY, KATLYN ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:FREY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TYLER AVE. APT. #7
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330
Mailing Address - Country:US
Mailing Address - Phone:618-697-5107
Mailing Address - Fax:
Practice Address - Street 1:303 N. HURSTBOURNE PARKWAY
Practice Address - Street 2:SUITE 200 PARAGON REHABILITATION
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A5940224Z00000X
IL057.003846224Z00000X
TX212660224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant