Provider Demographics
NPI:1639556897
Name:METCALF, KATY LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:LYNN
Last Name:METCALF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5282
Mailing Address - Country:US
Mailing Address - Phone:708-519-0284
Mailing Address - Fax:
Practice Address - Street 1:300 FREEDOM LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-0001
Practice Address - Country:US
Practice Address - Phone:949-643-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010480225X00000X
CAOT21040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist