Provider Demographics
NPI:1205156015
Name:METTLER, KATIE RAE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:RAE
Last Name:METTLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:RAE
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1550 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-4032
Mailing Address - Country:US
Mailing Address - Phone:701-371-0233
Mailing Address - Fax:
Practice Address - Street 1:1550 WOODRIDGE LN
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4032
Practice Address - Country:US
Practice Address - Phone:701-371-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND834225X00000X
MN102640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist