Provider Demographics
NPI:1831561083
Name:WOODARD, KATE A (COTA/L)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:A
Last Name:WOODARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1717
Mailing Address - Country:US
Mailing Address - Phone:314-651-8500
Mailing Address - Fax:
Practice Address - Street 1:20 E. MAIN
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1717
Practice Address - Country:US
Practice Address - Phone:314-651-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016208174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator