Provider Demographics
NPI:1902982606
Name:DOLE, KATHRYN NEOMA (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:NEOMA
Last Name:DOLE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 MORRILL LN
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3656
Mailing Address - Country:US
Mailing Address - Phone:612-724-2010
Mailing Address - Fax:612-722-6455
Practice Address - Street 1:2225 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1932
Practice Address - Country:US
Practice Address - Phone:612-668-5414
Practice Address - Fax:612-668-5446
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100667225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics