Provider Demographics
NPI:1508062365
Name:PETTERSON, CATHERINE MARIE (OT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:PETTERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-2488 KAUMUALII HWY
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8311
Mailing Address - Country:US
Mailing Address - Phone:808-977-8241
Mailing Address - Fax:
Practice Address - Street 1:4-901 KUHIO HWY
Practice Address - Street 2:UNIT A
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1576
Practice Address - Country:US
Practice Address - Phone:808-826-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0T-247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist