Healthcare Provider Details

I. General information

NPI: 1275960502
Provider Name (Legal Business Name): KATHERINE SYTNIAK MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/06/2026
Certification Date:
Deactivation Date: 10/10/2014
Reactivation Date: 10/06/2026

III. Provider practice location address

446 SNELLING AVE S
SAINT PAUL MN
55105-2147
US

IV. Provider business mailing address

446 SNELLING AVE S
SAINT PAUL MN
55105-2147
US

V. Phone/Fax

Practice location:
  • Phone: 734-474-9417
  • Fax:
Mailing address:
  • Phone: 734-474-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: