MEDICARE: KATHERINE STEWART DEWITT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	7433	SC
2	225XP0019X	Physical Rehabilitation Occupational Therapist	8054	NC

General Provider Information

NPI Number	:	1235536020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE STEWART DEWITT OTR/L

Provider Business Mailing Address
First Line	:	2045 MANILA BAY LN
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-8524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10660 PARK RD STE 3200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-8420
Country	:	US
Telephone Number	:	704-667-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	12/05/2024

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