Provider Demographics
NPI:1992360408
Name:CARTY, KATELYN LEE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:LEE
Last Name:CARTY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 BROAD WATER ARCH
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3550
Mailing Address - Country:US
Mailing Address - Phone:757-619-1731
Mailing Address - Fax:
Practice Address - Street 1:12997 NETTLES DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6913
Practice Address - Country:US
Practice Address - Phone:757-249-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist