Provider Demographics
NPI:1386777852
Name:UPDEGRAFF, KATHERINE J (OTRL)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:UPDEGRAFF
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 GLOUCESTER PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3343
Mailing Address - Country:US
Mailing Address - Phone:907-317-7957
Mailing Address - Fax:907-770-5755
Practice Address - Street 1:6711 GLOUCESTER PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3343
Practice Address - Country:US
Practice Address - Phone:907-317-7957
Practice Address - Fax:907-770-5755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1814225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics