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NPI Code Detail

MEDICARE: KATHERINE VANDERSTAD OTR/L

MEDICARE: KATHERINE VANDERSTAD 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
1225X00000XOccupational Therapist7420SC

General Provider Information

NPI Number : 1578385316
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE VANDERSTAD OTR/L
Provider Business Mailing Address
First Line : 604 BIRCHWOOD DR
Second Line :
City : WAXHAW
State : NC
Zip : 28173-6559
Country : US
Telephone Number : 973-767-7006
Fax Number :
Provider Business Practice Location Address
First Line : 85C VINCENT DR
Second Line :
City : MT PLEASANT
State : SC
Zip : 29464-4030
Country : US
Telephone Number : 843-822-2292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2024
Last Update Date : 10/31/2024

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Directions to “ KATHERINE VANDERSTAD OTR/L” Practice Location

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