Healthcare Provider Details

I. General information

NPI: 1104436823
Provider Name (Legal Business Name): MARY KATHERINE PATEL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 91ST AVE NE
LAKE STEVENS WA
98258-2530
US

IV. Provider business mailing address

320 10TH ST APT 3
KIRKLAND WA
98033-6356
US

V. Phone/Fax

Practice location:
  • Phone: 425-535-2690
  • Fax:
Mailing address:
  • Phone: 267-226-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number435843
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.OT.70173743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: