Provider Demographics
NPI:1073011045
Name:CRUTSINGER, KATHERINE LORRAINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LORRAINE
Last Name:CRUTSINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 FREMONT LN N APT 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8742
Mailing Address - Country:US
Mailing Address - Phone:310-990-8395
Mailing Address - Fax:
Practice Address - Street 1:1618 S LANE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2829
Practice Address - Country:US
Practice Address - Phone:206-899-7913
Practice Address - Fax:206-328-6241
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20881225X00000X
OR433876225X00000X
WAOT61100297225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program