Provider Demographics
NPI:1245678200
Name:EWERT, KATHRYN PW (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PW
Last Name:EWERT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:P
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2451 S TIMBERLINE RD APT 8-201
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4174
Mailing Address - Country:US
Mailing Address - Phone:785-341-1131
Mailing Address - Fax:
Practice Address - Street 1:2451 S TIMBERLINE RD APT 8-201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4174
Practice Address - Country:US
Practice Address - Phone:785-341-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCOTA-1005224Z00000X
COOT.0006653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant