Provider Demographics
NPI:1720772536
Name:LEWIS, KATHERINE CAMPBELL (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CAMPBELL
Last Name:LEWIS
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 1:1520 SOUTH BLVD STE 228
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-3718
Mailing Address - Country:US
Mailing Address - Phone:704-569-5489
Mailing Address - Fax:
Practice Address - Street 1:1520 SOUTH BLVD STE 228
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-3718
Practice Address - Country:US
Practice Address - Phone:704-569-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist