Healthcare Provider Details

I. General information

NPI: 1871017251
Provider Name (Legal Business Name): KATHRYN ELLEN PAGE JEYATHEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN PAGE

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E HUDSON BLVD
GASTONIA NC
28054-6102
US

IV. Provider business mailing address

3424 MADRIGAL LN
CHARLOTTE NC
28214-2384
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number11143
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: