Healthcare Provider Details

I. General information

NPI: 1225968563
Provider Name (Legal Business Name): KATHERINE L FORTNEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

205 PARK ST
FORT ATKINSON WI
53538-2148
US

IV. Provider business mailing address

201 PARK ST
FORT ATKINSON WI
53538-2155
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-7828
  • Fax:
Mailing address:
  • Phone: 920-563-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number296888
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: