Provider Demographics
NPI:1508294448
Name:CARRASCO, KATHLEA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEA
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 MACOMB ST NW
Mailing Address - Street 2:#211
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3853
Mailing Address - Country:US
Mailing Address - Phone:510-449-2178
Mailing Address - Fax:
Practice Address - Street 1:3725 MACOMB ST NW
Practice Address - Street 2:#211
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3853
Practice Address - Country:US
Practice Address - Phone:510-449-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist