Provider Demographics
NPI:1841448495
Name:MINTZ, KATRINA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:MINTZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1174 MADDY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4118
Mailing Address - Country:US
Mailing Address - Phone:503-390-0661
Mailing Address - Fax:
Practice Address - Street 1:5210 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4568
Practice Address - Country:US
Practice Address - Phone:503-393-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR247693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist