Provider Demographics
NPI:1811374481
Name:HARTSHORN, CATHERINE L (COTA/L, CMLDT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:COTA/L, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-5119
Mailing Address - Country:US
Mailing Address - Phone:386-456-7211
Mailing Address - Fax:
Practice Address - Street 1:125 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5119
Practice Address - Country:US
Practice Address - Phone:386-456-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13582224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant