Provider Demographics
NPI:1962668939
Name:WATKINS, KATHRYN DARLENE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DARLENE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:DARLENE
Other - Last Name:REES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3625 WHITEHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135
Mailing Address - Country:US
Mailing Address - Phone:901-210-3212
Mailing Address - Fax:
Practice Address - Street 1:955 GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-754-1393
Practice Address - Fax:901-751-9799
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN608224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant