Provider Demographics
NPI:1790841104
Name:LOVE, KATIE
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:LOVE
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 1:217 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2527
Mailing Address - Country:US
Mailing Address - Phone:770-748-3338
Mailing Address - Fax:
Practice Address - Street 1:119 E GIRARD AVE
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2711
Practice Address - Country:US
Practice Address - Phone:770-748-4411
Practice Address - Fax:770-748-9544
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist