Provider Demographics
NPI:1063786960
Name:DISCAVAGE, KATHERINE ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANN
Last Name:DISCAVAGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48347-1343
Mailing Address - Country:US
Mailing Address - Phone:410-796-8499
Mailing Address - Fax:877-384-9028
Practice Address - Street 1:8955 GUILFORD RD
Practice Address - Street 2:STE 120
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2651
Practice Address - Country:US
Practice Address - Phone:410-796-8499
Practice Address - Fax:877-384-9028
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist