Provider Demographics
NPI:1063782225
Name:GORT, KATHERINE ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:GORT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 SILVER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5826
Mailing Address - Country:US
Mailing Address - Phone:318-518-4619
Mailing Address - Fax:281-344-1807
Practice Address - Street 1:1500 JACKSON ST
Practice Address - Street 2:300
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3668
Practice Address - Country:US
Practice Address - Phone:281-344-1808
Practice Address - Fax:281-344-1807
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114298174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist