Provider Demographics
NPI:1962919167
Name:VONDERSAAR, KATIE (OTR)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:VONDERSAAR
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:STEVONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:701 FOREST POINT CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6629
Practice Address - Country:US
Practice Address - Phone:980-375-6801
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist