Provider Demographics
NPI:1265934038
Name:BOOTH, KATIE C (OTR/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:BOOTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8041
Mailing Address - Country:US
Mailing Address - Phone:616-690-2108
Mailing Address - Fax:
Practice Address - Street 1:300 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8041
Practice Address - Country:US
Practice Address - Phone:231-832-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist