Healthcare Provider Details

I. General information

NPI: 1619372836
Provider Name (Legal Business Name): KATHERINE ELISABETH SOLEIL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PASEO DE PERALTA
SANTA FE NM
87501-1860
US

IV. Provider business mailing address

303 PASEO DE PERALTA
SANTA FE NM
87501-1860
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2449
  • Fax: 505-986-6005
Mailing address:
  • Phone: 206-778-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9458
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11552301-4201
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0006275
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number306084
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20789
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: