Provider Demographics
NPI:1962068585
Name:VAUGHT, KATHLEEN FRANCES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 US ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-8694
Mailing Address - Country:US
Mailing Address - Phone:513-239-0990
Mailing Address - Fax:
Practice Address - Street 1:2040 US ROUTE 50
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-8694
Practice Address - Country:US
Practice Address - Phone:513-239-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT005690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT005690Medicaid