Provider Demographics
NPI:1952677361
Name:CROFT, KATHI J (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:J
Last Name:CROFT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CULBERT LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3504
Mailing Address - Country:US
Mailing Address - Phone:218-749-2445
Mailing Address - Fax:
Practice Address - Street 1:901 9TH ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2325
Practice Address - Country:US
Practice Address - Phone:218-749-9405
Practice Address - Fax:218-749-9407
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20064224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant