Basic Information
| Provider Information | |||||||||
| NPI: | 1811219132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRISH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 S HOLMEN DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HOLMEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546369467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085269888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 S HOLMEN DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HOLMEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546369467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085269888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5348-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 41230300 | 05 | WI | MEDICAID |