Provider Demographics
NPI:1821589961
Name:MAYER, KATHERINE RAE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:RAE
Last Name:MAYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KATHIE
Other - Middle Name:
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:314 MILROY ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4930
Mailing Address - Country:US
Mailing Address - Phone:360-463-8488
Mailing Address - Fax:
Practice Address - Street 1:314 MILROY ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4930
Practice Address - Country:US
Practice Address - Phone:360-463-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000649225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT00000649OtherLICENSE