Provider Demographics
NPI:1790916914
Name:ANDERSON, KATHERINE (OT/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OCEAN PKWY APT 5J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2522
Mailing Address - Country:US
Mailing Address - Phone:347-526-5672
Mailing Address - Fax:
Practice Address - Street 1:125 OCEAN PKWY APT 5J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2522
Practice Address - Country:US
Practice Address - Phone:347-526-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009937225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics