Provider Demographics
NPI:1063765824
Name:VERNON, KATHERINE REECE (OTR)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:REECE
Last Name:VERNON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22499
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2499
Mailing Address - Country:US
Mailing Address - Phone:503-496-0385
Mailing Address - Fax:503-496-0787
Practice Address - Street 1:10600 SE MCLOUGHLIN BLVD
Practice Address - Street 2:STE 202
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7428
Practice Address - Country:US
Practice Address - Phone:503-496-0385
Practice Address - Fax:503-496-0787
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR296671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist