Provider Demographics
NPI:1316178833
Name:JOE, MARIE KATRINA (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:KATRINA
Last Name:JOE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:
Other - Last Name:JOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:15151 BERRY TRAIL
Mailing Address - Street 2:#201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-7524
Mailing Address - Country:US
Mailing Address - Phone:214-336-5311
Mailing Address - Fax:
Practice Address - Street 1:15151 BERRY TRAIL
Practice Address - Street 2:#201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-7524
Practice Address - Country:US
Practice Address - Phone:214-336-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110618225X00000X
CA10261225X00000X
HI926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist