Provider Demographics
NPI:1417265182
Name:MAKINSON, GRETCHEN LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LEE
Last Name:MAKINSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:LEE
Other - Last Name:HEEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3205
Mailing Address - Country:US
Mailing Address - Phone:509-943-1264
Mailing Address - Fax:
Practice Address - Street 1:1321 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3205
Practice Address - Country:US
Practice Address - Phone:509-943-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist