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NPI Code Detail

MEDICARE: MRS. KATELYN AMANDA TRAVIS MSOTR/L

MEDICARE: MRS. KATELYN AMANDA TRAVIS MSOTR/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 TherapistOT009812GA
2225X00000XOccupational Therapist7482SC

General Provider Information

NPI Number : 1336505361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATELYN AMANDA TRAVIS MSOTR/L
Provider Business Mailing Address
First Line : 200 WINDRIDGE LN APT 5
Second Line :
City : FLORENCE
State : KY
Zip : 41042-9422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 714 S LAKE DR STE 150
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3473
Country : US
Telephone Number : 803-356-4782
Fax Number : 803-642-0588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2016
Last Update Date : 04/02/2026

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