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General NPI Number Information
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NPI Number | 1558916155
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE CHAMPIE OT,PT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 6909 HEUERMANN RD
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City | SAN ANTONIO
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State | TX
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Zip | 78256
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Country | US
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Telephone | 210-899-4807
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Fax |
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Provider Business Mailing Address
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Address Line | 28729 DAPPER DAN DR
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City | FAIR OAKS RANCH
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State | TX
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Zip | 78015-4829
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Country | US
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Telephone | 210-288-4378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 103319
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1110013
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License Number State | TX
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