Provider Demographics
NPI:1356588842
Name:LAWDIS, KATINA (MS,OTR/L)
Entity type:Individual
Prefix:MISS
First Name:KATINA
Middle Name:
Last Name:LAWDIS
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 1:61 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3915
Mailing Address - Country:US
Mailing Address - Phone:617-650-6782
Mailing Address - Fax:
Practice Address - Street 1:475 FRANKLIN ST
Practice Address - Street 2:#201
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6264
Practice Address - Country:US
Practice Address - Phone:508-877-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist