Provider Demographics
NPI:1851493340
Name:PETERSON, KATHRYN SCHULZ (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SCHULZ
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4518
Mailing Address - Country:US
Mailing Address - Phone:561-395-2924
Mailing Address - Fax:
Practice Address - Street 1:1122 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-4518
Practice Address - Country:US
Practice Address - Phone:561-395-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885750400Medicaid