Provider Demographics
NPI:1851759047
Name:TITUS, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TITUS
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 1:670 W FORTH STREET
Mailing Address - Street 2:PO BOX 805
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-0805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 W 4TH ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-5092
Practice Address - Country:US
Practice Address - Phone:361-564-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist