MEDICARE: KATHRYN ANNE DAVITT OT

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	110132	TX
2	225XP0200X	Pediatric Occupational Therapist	110132	TX

General Provider Information

NPI Number	:	1699924910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANNE DAVITT OT

Provider Business Mailing Address
First Line	:	3550 HULEN ST STE D
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6885
Country	:	US
Telephone Number	:	817-377-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 HULEN ST STE D
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6885
Country	:	US
Telephone Number	:	817-377-2535
Fax Number	:

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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