MEDICARE: KATHERINE MOTTELER BRANCH OTR/L, CHT

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
1	225X00000X	Occupational Therapist	OT007242	GA
2	225X00000X	Occupational Therapist	3947	AL

General Provider Information

NPI Number	:	1851757199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MOTTELER BRANCH OTR/L, CHT

Provider Business Mailing Address
First Line	:	4109 HIGHWAY 98 W
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9132
Country	:	US
Telephone Number	:	601-276-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 W BELMONT DR STE 12
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-3064
Country	:	US
Telephone Number	:	706-625-0662
Fax Number	:	706-625-0582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	07/05/2024

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