Healthcare Provider Details

I. General information

NPI: 1548513682
Provider Name (Legal Business Name): KATIE LEIGH FAIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 HARRINGTON HWY
EDEN NC
27288-7547
US

IV. Provider business mailing address

514 MAGGY VALLEY RD
REIDSVILLE NC
27320-7398
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-2600
  • Fax:
Mailing address:
  • Phone: 336-254-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: