MEDICARE: MS. MARIE KATRINA JOE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	110618	TX
2	225X00000X	Occupational Therapist	10261	CA
3	225X00000X	Occupational Therapist	926	HI

General Provider Information

NPI Number	:	1316178833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE KATRINA JOE OTR

Provider Business Mailing Address
First Line	:	15151 BERRY TRAIL
Second Line	:	#201
City	:	DALLAS
State	:	TX
Zip	:	75248-7524
Country	:	US
Telephone Number	:	214-336-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	15151 BERRY TRAIL
Second Line	:	#201
City	:	DALLAS
State	:	TX
Zip	:	75248-7524
Country	:	US
Telephone Number	:	214-336-5311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/31/2009

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