Provider Demographics
NPI:1912071432
Name:DRADER, KATHRYN (OT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DRADER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 E TRENT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1347
Mailing Address - Country:US
Mailing Address - Phone:509-535-6050
Mailing Address - Fax:509-535-6051
Practice Address - Street 1:4305 E TRENT
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1347
Practice Address - Country:US
Practice Address - Phone:509-535-6050
Practice Address - Fax:509-535-6051
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800296OtherMEDICARE GROUP
WA8855155Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST