Provider Demographics
NPI:1194302364
Name:MRSKATIEOTR, LLC
Entity type:Organization
Organization Name:MRSKATIEOTR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:772-217-9376
Mailing Address - Street 1:1841 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3089
Mailing Address - Country:US
Mailing Address - Phone:772-217-9376
Mailing Address - Fax:833-478-1300
Practice Address - Street 1:1841 21ST AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3089
Practice Address - Country:US
Practice Address - Phone:772-217-9376
Practice Address - Fax:833-478-1300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRSKATIEOTR, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty