Healthcare Provider Details

I. General information

NPI: 1073011045
Provider Name (Legal Business Name): KATHERINE LORRAINE CRUTSINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 12/09/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 S LANE ST
SEATTLE WA
98144-2829
US

IV. Provider business mailing address

3636 FREMONT LN N APT 102
SEATTLE WA
98103-8742
US

V. Phone/Fax

Practice location:
  • Phone: 206-899-7913
  • Fax: 206-328-6241
Mailing address:
  • Phone: 310-990-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20881
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number433876
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61100297
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: