Provider Demographics
NPI:1992467104
Name:VAN GURP, KATHERINE BROOKS (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BROOKS
Last Name:VAN GURP
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 1:337 KINDLING WOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6802
Mailing Address - Country:US
Mailing Address - Phone:704-936-7000
Mailing Address - Fax:
Practice Address - Street 1:3620 COVENANT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4216
Practice Address - Country:US
Practice Address - Phone:803-787-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14346225X00000X
SC6323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist