Provider Demographics
NPI:1326136409
Name:KATZ, NAOMI (OTR)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:KATZ
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-0245
Mailing Address - Country:US
Mailing Address - Phone:541-608-0464
Mailing Address - Fax:541-535-5593
Practice Address - Street 1:158 SHARON DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-5713
Practice Address - Country:US
Practice Address - Phone:541-608-0464
Practice Address - Fax:541-535-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158747Medicaid
ORP59368Medicare UPIN
ORR113169Medicare PIN