Provider Demographics
NPI:1245480383
Name:HERTEL, KATHERINE ANNE (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANNE
Last Name:HERTEL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LEE HWY
Mailing Address - Street 2:APT. 704
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3159
Mailing Address - Country:US
Mailing Address - Phone:703-568-5901
Mailing Address - Fax:
Practice Address - Street 1:4201 LEE HWY
Practice Address - Street 2:APT. 704
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3159
Practice Address - Country:US
Practice Address - Phone:703-568-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004001225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics