Provider Demographics
NPI:1154516086
Name:BURKHOLDER, KATRINA ANN (OTRL OCCUPATIONAL TH)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:ANN
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:OTRL OCCUPATIONAL TH
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19930 BALLINGER WAY NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1223
Mailing Address - Country:US
Mailing Address - Phone:206-363-6947
Mailing Address - Fax:206-417-6947
Practice Address - Street 1:19930 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1223
Practice Address - Country:US
Practice Address - Phone:206-363-6947
Practice Address - Fax:206-417-6947
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT822225X00000X
002870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist