Healthcare Provider Details

I. General information

NPI: 1437750825
Provider Name (Legal Business Name): KATE LYNN KOWALYSHEN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 MCCONNELL DR STE B
DECATUR GA
30033-3507
US

IV. Provider business mailing address

465 MEMORIAL DR SE UNIT 320
ATLANTA GA
30312-2283
US

V. Phone/Fax

Practice location:
  • Phone: 404-521-4121
  • Fax:
Mailing address:
  • Phone: 630-696-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: