Healthcare Provider Details

I. General information

NPI: 1467425108
Provider Name (Legal Business Name): CATHERINE WILLIS OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE KNOCHE

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 4TH ST SUITE B
REDMOND OR
97756-1328
US

IV. Provider business mailing address

PO BOX 24988
SEATTLE WA
98124-0988
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-7494
  • Fax: 541-504-9153
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1066077
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: