Basic Information
| Provider Information | |||||||||
| NPI: | 1760437370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DITTO | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2767 SPOONBILL TRL | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320731655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045427503 | ||||||||
| FaxNumber: | 9045427291 | ||||||||
| Practice Location | |||||||||
| Address1: | 2080 CHILD ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322145005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045427503 | ||||||||
| FaxNumber: | 9045427291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.