Provider Demographics
NPI:1902632441
Name:FAULK, KATIE (OTD)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:FAULK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2267
Mailing Address - Country:US
Mailing Address - Phone:985-580-9922
Mailing Address - Fax:985-580-9921
Practice Address - Street 1:6500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2267
Practice Address - Country:US
Practice Address - Phone:985-580-9922
Practice Address - Fax:985-580-9921
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343868225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist