Provider Demographics
NPI:1720114523
Name:PITTS, KATHY R (OT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:R
Last Name:PITTS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:FEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3210 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4224
Mailing Address - Country:US
Mailing Address - Phone:850-763-0603
Mailing Address - Fax:850-769-5914
Practice Address - Street 1:3210 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:850-763-0603
Practice Address - Fax:850-769-5914
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3288225X00000X
LA303644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593372143OtherTHERAPY ONE REHABILITATION CENTER