MEDICARE: KATHERINE FLETCHER MS, 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	OT006260	GA

General Provider Information

NPI Number	:	1295103836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE FLETCHER MS, OTR/L

Provider Business Mailing Address
First Line	:	798 MILL BEND DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-6145
Country	:	US
Telephone Number	:	404-625-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 PIPEMAKERS CIR STE 115
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4168
Country	:	US
Telephone Number	:	912-988-1526
Fax Number	:

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

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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