Provider Demographics
NPI:1619635687
Name:EPPS, KATIE WIKAN (COTA/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:WIKAN
Last Name:EPPS
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 INGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3510
Mailing Address - Country:US
Mailing Address - Phone:757-714-9207
Mailing Address - Fax:
Practice Address - Street 1:12997 NETTLES DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6913
Practice Address - Country:US
Practice Address - Phone:757-249-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002044224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant