Provider Demographics
NPI:1972789865
Name:WELBAUM, KATHERINE A (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:WELBAUM
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:WENDT (GARD)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 SPRINGFIELD ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-236-9965
Mailing Address - Fax:937-233-0161
Practice Address - Street 1:4801 SPRINGFIELD ST.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-236-9965
Practice Address - Fax:937-233-0161
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-03381224Z00000X
OHOT.007380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant