Provider Demographics
NPI:1992854301
Name:JONES, KATHERINE GWYNNE (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:GWYNNE
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 ASHER VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4852
Mailing Address - Country:US
Mailing Address - Phone:919-260-8719
Mailing Address - Fax:
Practice Address - Street 1:3500 REGENCY PKWY
Practice Address - Street 2:STE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-8519
Practice Address - Country:US
Practice Address - Phone:919-465-3966
Practice Address - Fax:919-465-3886
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5592225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138EKOtherBLUE CROSS BLUE SHIELD