Provider Demographics
NPI:1023710225
Name:STANLEY, KATHERINE ELAINE (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELAINE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 MEADOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2634
Mailing Address - Country:US
Mailing Address - Phone:614-597-4059
Mailing Address - Fax:
Practice Address - Street 1:60 PACELINE CIR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1281
Practice Address - Country:US
Practice Address - Phone:614-597-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA008394224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant