Provider Demographics
NPI:1184190910
Name:MURPHY, KATELYN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:MURPHY
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 1:620 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-4938
Mailing Address - Country:US
Mailing Address - Phone:615-974-6176
Mailing Address - Fax:
Practice Address - Street 1:812 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1009
Practice Address - Country:US
Practice Address - Phone:615-446-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN402840224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant