Individual
CAITLYNN SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
203 S WESTERN AVE, TONASKET, WA 98855-8803
(509) 486-2151
Mailing address
203 S. WESTERN AVE, C/O: CREDENTIALING, TONASKET, WA 98855
(509) 486-3144
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
69003
WA
225X00000X
Occupational Therapist
Primary
OT61109008
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60731842
WASHINGTON STATE DEPARTMENT OF HEALTH RECREATION THERAPIST REGISTRATION
WA
Enumeration date
04/18/2017
Last updated
01/22/2024
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