Healthcare Provider Details

I. General information

NPI: 1861170029
Provider Name (Legal Business Name): KATHRYN MCNUTT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ADRIS PL
DOTHAN AL
36303-1997
US

IV. Provider business mailing address

118 ADRIS PL
DOTHAN AL
36303-1997
US

V. Phone/Fax

Practice location:
  • Phone: 334-677-6360
  • Fax: 334-678-6540
Mailing address:
  • Phone: 346-776-3603
  • Fax: 334-678-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4974
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: