Provider Demographics
NPI:1720647068
Name:JAMES, KATELYN NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICOLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:NICOLE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W 12TH ST STE A1-100
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4771
Mailing Address - Country:US
Mailing Address - Phone:540-941-5501
Mailing Address - Fax:540-941-5502
Practice Address - Street 1:200 W 12TH ST STE A1-100
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4771
Practice Address - Country:US
Practice Address - Phone:540-941-5501
Practice Address - Fax:540-941-5502
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-008217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist