Provider Demographics
NPI:1760095962
Name:PEREZ, KATRINA-NADINE MAANAO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATRINA-NADINE
Middle Name:MAANAO
Last Name:PEREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 DANIALS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6203
Mailing Address - Country:US
Mailing Address - Phone:360-918-4539
Mailing Address - Fax:
Practice Address - Street 1:MEADOWS ELEMENTARY SCHOOL
Practice Address - Street 2:836 DEERBRUSH DRIVE SE
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513
Practice Address - Country:US
Practice Address - Phone:360-412-4690
Practice Address - Fax:360-412-4699
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61081671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist