Provider Demographics
NPI:1255538047
Name:IRVIN, KATIE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6640
Mailing Address - Country:US
Mailing Address - Phone:360-452-9206
Mailing Address - Fax:360-452-5117
Practice Address - Street 1:1116 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6640
Practice Address - Country:US
Practice Address - Phone:360-452-9206
Practice Address - Fax:360-452-5117
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60473570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist