Provider Demographics
NPI:1760182976
Name:CASTRO, JADE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:DREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:793 RACE RD
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-9576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 SW KIMBALL DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7593
Practice Address - Country:US
Practice Address - Phone:360-320-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61226557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist