Healthcare Provider Details

I. General information

NPI: 1588583934
Provider Name (Legal Business Name): KATHERINE YVONNE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 WALDORF MARKET PL
WALDORF MD
20603-4872
US

IV. Provider business mailing address

23000 MOAKLEY ST STE 102
LEONARDTOWN MD
20650-2916
US

V. Phone/Fax

Practice location:
  • Phone: 240-530-8188
  • Fax:
Mailing address:
  • Phone: 301-475-5555
  • Fax: 301-475-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10791
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: