Healthcare Provider Details

I. General information

NPI: 1316383177
Provider Name (Legal Business Name): KATHLEEN MARIE BRANCH OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE HOLFORD OTD, OTR/L

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 3RD AVE S
SEATTLE WA
98134-1923
US

IV. Provider business mailing address

2202 179TH ST SE
BOTHELL WA
98012-6557
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-4420
  • Fax:
Mailing address:
  • Phone: 310-435-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number14853
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number60574382
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: