Healthcare Provider Details

I. General information

NPI: 1396361424
Provider Name (Legal Business Name): KATELYN ROSE HARRIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATELYN ROSE FAWCETT

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

5701 E 8TH AVE APT 313
DENVER CO
80220-4538
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone: 949-939-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0006442
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: