Healthcare Provider Details

I. General information

NPI: 1205766037
Provider Name (Legal Business Name): KATHRYN WOLFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 MONROE ST
LA PORTE IN
46350-6186
US

IV. Provider business mailing address

30195 TYLER RD
WALKERTON IN
46574-8734
US

V. Phone/Fax

Practice location:
  • Phone: 269-492-4476
  • Fax: 269-492-4476
Mailing address:
  • Phone: 269-492-4476
  • Fax: 269-492-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005337A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: