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General NPI Number Information
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NPI Number | 1669989620
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Entity Type | Individual
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Provider Name | KATHERINE O'CONNOR
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Gender | Female
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 24865 DETROIT RD
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City | WESTLAKE
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State | OH
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Zip | 44145-2512
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Country | US
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Telephone | 440-250-8508
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 VANDALIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44144-3948
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 16808
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-16808
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License Number State | OH
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