Provider Demographics
NPI:1053012369
Name:TRIPLETT, KATHERINE (COTA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 CLAIREN DR
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-1054
Mailing Address - Country:US
Mailing Address - Phone:314-952-2478
Mailing Address - Fax:
Practice Address - Street 1:2025 HANLEY RD
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-6734
Practice Address - Country:US
Practice Address - Phone:636-561-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021047351224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant