Provider Demographics
NPI:1851757199
Name:BRANCH, KATHERINE MOTTELER (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MOTTELER
Last Name:BRANCH
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 HIGHWAY 98 W
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-9132
Mailing Address - Country:US
Mailing Address - Phone:601-276-3900
Mailing Address - Fax:
Practice Address - Street 1:136 W BELMONT DR STE 12
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3064
Practice Address - Country:US
Practice Address - Phone:706-625-0662
Practice Address - Fax:706-625-0582
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007242225X00000X
AL3947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist