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General NPI Number Information
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NPI Number | 1639821135
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Entity Type | Individual
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Provider Name | CATHERINE HASTERLO OTR/L, CLT
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Gender | Female
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 4200 S. 4TH STREET
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5024
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Country | US
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Telephone | 913-758-6542
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 NW BROAD ST
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City | MURFREESBORO
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State | TN
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Zip | 37129-4428
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Country | US
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Telephone |
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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 | 2018043668
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17-03503
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License Number State | KS
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