Healthcare Provider Details

I. General information

NPI: 1154036408
Provider Name (Legal Business Name): KATLYN SENECA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SUGAR PINE DR
PINEHURST NC
28374-9307
US

IV. Provider business mailing address

255 SUGAR PINE DR
PINEHURST NC
28374-9307
US

V. Phone/Fax

Practice location:
  • Phone: 910-315-6279
  • Fax:
Mailing address:
  • Phone: 910-315-6279
  • Fax: 910-483-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31006794A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: