Provider Demographics
NPI:1952959314
Name:WEATHERSBEE, KATHRYN LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:WEATHERSBEE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEE
Other - Last Name:SCHORTINGHUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3618 J DEWEY GRAY CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1867
Mailing Address - Country:US
Mailing Address - Phone:706-860-7574
Mailing Address - Fax:
Practice Address - Street 1:3618 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1867
Practice Address - Country:US
Practice Address - Phone:706-860-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001530224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant