Provider Demographics
NPI:1386262491
Name:CARGILE, KATHRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CARGILE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PYRON PT
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2363
Mailing Address - Country:US
Mailing Address - Phone:404-309-9568
Mailing Address - Fax:
Practice Address - Street 1:101 DEVANT ST STE 703
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2717
Practice Address - Country:US
Practice Address - Phone:404-309-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist