Provider Demographics
NPI:1396289740
Name:FOSTER, KATHLEEN (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 GILPIN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2308
Mailing Address - Country:US
Mailing Address - Phone:610-716-5320
Mailing Address - Fax:
Practice Address - Street 1:44 DEERING AVE
Practice Address - Street 2:APT. 2
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2292
Practice Address - Country:US
Practice Address - Phone:610-716-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA3257224Z00000X
DEU2-0001852224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant