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NPI Code Detail

MEDICARE: KATELYNN PETTIS OTR/L

MEDICARE: KATELYNN PETTIS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2225X00000XOccupational Therapist5561AL

General Provider Information

NPI Number : 1134856370
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYNN PETTIS OTR/L
Provider Business Mailing Address
First Line : 201 2ND AVE W APT 301
Second Line :
City : CENTRE
State : AL
Zip : 35960-1907
Country : US
Telephone Number : 256-557-8635
Fax Number :
Provider Business Practice Location Address
First Line : 307 GRAND AVE NW
Second Line :
City : FORT PAYNE
State : AL
Zip : 35967-2109
Country : US
Telephone Number : 256-601-3015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2022
Last Update Date : 08/08/2022

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Directions to “ KATELYNN PETTIS OTR/L” Practice Location

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