Provider Demographics
NPI:1477254381
Name:DICK, KATIE ANNE (MSOT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:ANNE
Last Name:DICK
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 HARRIS PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5758
Mailing Address - Country:US
Mailing Address - Phone:302-650-8890
Mailing Address - Fax:
Practice Address - Street 1:1502 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2148
Practice Address - Country:US
Practice Address - Phone:302-552-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0012460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist