Provider Demographics
NPI:1316298490
Name:BROGAN, KATHLEEN JULIA (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JULIA
Last Name:BROGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BATTAGLIA BROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3705 RIVERCHASE PL
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1818
Mailing Address - Country:US
Mailing Address - Phone:804-747-3929
Mailing Address - Fax:
Practice Address - Street 1:3705 RIVERCHASE PL
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1818
Practice Address - Country:US
Practice Address - Phone:804-747-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist