Provider Demographics
NPI:1134842404
Name:PRIBISH, KATIE MARIE (MOT, OTR)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:PRIBISH
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROANOKE ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3037
Mailing Address - Country:US
Mailing Address - Phone:814-241-6807
Mailing Address - Fax:
Practice Address - Street 1:1997 S MAIN ST STE 601
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6606
Practice Address - Country:US
Practice Address - Phone:540-961-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics