Provider Demographics
NPI:1881866853
Name:VISSING, KATHRYN W (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:W
Last Name:VISSING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:W
Other - Last Name:VISSING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:10749 JACOBS CT
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9461
Mailing Address - Country:US
Mailing Address - Phone:317-313-7677
Mailing Address - Fax:317-336-7602
Practice Address - Street 1:10749 JACOBS CT
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-9461
Practice Address - Country:US
Practice Address - Phone:317-313-7677
Practice Address - Fax:317-336-7602
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000515A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist