Provider Demographics
NPI:1295581874
Name:PATHWAY TO POTENTIAL OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:PATHWAY TO POTENTIAL OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-504-2257
Mailing Address - Street 1:104 MONTEGA LN
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-6655
Mailing Address - Country:US
Mailing Address - Phone:502-504-2257
Mailing Address - Fax:
Practice Address - Street 1:104 MONTEGA LN
Practice Address - Street 2:
Practice Address - City:COXS CREEK
Practice Address - State:KY
Practice Address - Zip Code:40013-6655
Practice Address - Country:US
Practice Address - Phone:502-504-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist