Individual
KATHLEEN ROSE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31006599A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31006599A
INDIANA MEDICAL LICENSE
IN
Enumeration date
05/10/2018
Last updated
01/20/2025
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