Healthcare Provider Details

I. General information

NPI: 1295984045
Provider Name (Legal Business Name): KATHERINE KOWALSKI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WATER ST SUITE C 104
PLYMOUTH MA
02360-4060
US

IV. Provider business mailing address

225 WATER ST SUITE C 104
PLYMOUTH MA
02360-4060
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-4434
  • Fax: 508-746-4432
Mailing address:
  • Phone: 508-746-4434
  • Fax: 508-746-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: