Individual
MRS. CATHERINE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1066077
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
339238
PROVIDENCE
—
01
—
H254810
PACIFIC SOURCE BCBS
OR
Enumeration date
02/13/2006
Last updated
10/15/2007
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