MEDICARE: KATHERINE LORRAINE CRUTSINGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	20881	CA
2	225X00000X	Occupational Therapist	433876	OR
3	225X00000X	Occupational Therapist	OT61100297	WA
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073011045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LORRAINE CRUTSINGER

Provider Business Mailing Address
First Line	:	3636 FREMONT LN N APT 102
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8742
Country	:	US
Telephone Number	:	310-990-8395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 S LANE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2829
Country	:	US
Telephone Number	:	206-899-7913
Fax Number	:	206-328-6241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	12/09/2020

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