Healthcare Provider Details

I. General information

NPI: 1164648598
Provider Name (Legal Business Name): KATHERINE ROBERTSON MCRAE M.S., OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CLIFTON RD NE
ATLANTA GA
30322-1004
US

IV. Provider business mailing address

483 CRICKET RIDGE CT
LAWRENCEVILLE GA
30044-5373
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5512
  • Fax:
Mailing address:
  • Phone: 770-985-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000613
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: