Provider Demographics
NPI:1902963663
Name:NICE, KATHRYN ANN GORRES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN GORRES
Last Name:NICE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:NICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:952-525-4500
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1222
Practice Address - Country:US
Practice Address - Phone:952-525-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102378225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist