Provider Demographics
NPI:1336505361
Name:TRAVIS, KATELYN AMANDA (MSOTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:AMANDA
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MSOTR/L
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Mailing Address - Street 1:200 WINDRIDGE LN APT 5
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 S LAKE DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3473
Practice Address - Country:US
Practice Address - Phone:803-356-4782
Practice Address - Fax:803-642-0588
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
225X00000X
SC7482225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist