Individual
KATE COSTELLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
13501 NE 28TH ST, VANCOUVER, WA 98682-8091
(360) 604-6700
Mailing address
5110 NE GLISAN ST, PORTLAND, OR 97213-2940
(360) 888-6989
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT00002913
WA
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7683444
—
WA
Enumeration date
04/03/2007
Last updated
01/23/2013
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