Provider Demographics
NPI:1821648098
Name:BUTTAFARRO, KATIE L (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:BUTTAFARRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 OAK LEAF CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2159
Mailing Address - Country:US
Mailing Address - Phone:716-720-1572
Mailing Address - Fax:
Practice Address - Street 1:7820 BALTUSROL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3270
Practice Address - Country:US
Practice Address - Phone:703-468-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist