Provider Demographics
NPI:1548841190
Name:PARKER, KATHRYN (MS-OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PARKER
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 1:3765 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8060
Mailing Address - Country:US
Mailing Address - Phone:404-435-3839
Mailing Address - Fax:
Practice Address - Street 1:4530 NELSON BROGDON BLVD STE C
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5407
Practice Address - Country:US
Practice Address - Phone:678-820-9606
Practice Address - Fax:844-820-9616
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist