Provider Demographics
NPI:1952636680
Name:MESTDAGH, KATHERINE JEAN (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
Last Name:MESTDAGH
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JEAN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22314 QUAIL RUN WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3119
Mailing Address - Country:US
Mailing Address - Phone:720-971-6075
Mailing Address - Fax:
Practice Address - Street 1:22314 QUAIL RUN WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3119
Practice Address - Country:US
Practice Address - Phone:720-971-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0000962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist