Provider Demographics
NPI:1164405742
Name:STEVENS, KATHERINE A (OTR)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NW FLANDERS ST
Mailing Address - Street 2:STE G-1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-224-9270
Mailing Address - Fax:503-224-9271
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE G-1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-224-9270
Practice Address - Fax:503-224-9271
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1031476225XH1200X
WAOT00003250225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA130651OtherWA L&I
OR098565014OtherBCBSO
WA8419939Medicaid
OR231754Medicaid
WA8853388Medicare ID - Type Unspecified
OR231754Medicaid
WA130651OtherWA L&I