Provider Demographics
NPI:1871908129
Name:ANDERSON, KATHERINE GERALDINE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GERALDINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:GERALDINE
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:21910 1ST PL W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8224
Mailing Address - Country:US
Mailing Address - Phone:206-697-0489
Mailing Address - Fax:
Practice Address - Street 1:10516 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3714
Practice Address - Country:US
Practice Address - Phone:206-697-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist