Provider Demographics
NPI:1699479394
Name:THOMAS, KATELYN VICTORIA (OTR)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:VICTORIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 FM 559
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-6046
Mailing Address - Country:US
Mailing Address - Phone:903-277-0077
Mailing Address - Fax:
Practice Address - Street 1:5256 FM 559
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-6046
Practice Address - Country:US
Practice Address - Phone:903-277-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist