Provider Demographics
NPI:1063623213
Name:CALDWELL, KATHERINE
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N BELFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4904
Mailing Address - Country:US
Mailing Address - Phone:610-449-1600
Mailing Address - Fax:
Practice Address - Street 1:1 N BELFIELD AVE
Practice Address - Street 2:SUNNY DAYS
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4904
Practice Address - Country:US
Practice Address - Phone:610-449-1600
Practice Address - Fax:610-449-2655
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018576590001Medicaid