Provider Demographics
NPI:1467425108
Name:WILLIS, CATHERINE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:KNOCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24988
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0988
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:1315 NW 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1328
Practice Address - Country:US
Practice Address - Phone:541-923-7494
Practice Address - Fax:541-504-9153
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1066077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
339238OtherPROVIDENCE
ORH254810OtherPACIFIC SOURCE BCBS
132210Medicare ID - Type Unspecified