Provider Demographics
NPI:1215272356
Name:NEELY, KATHERINE SHIZUE TAMURA (OTD, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:SHIZUE TAMURA
Last Name:NEELY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6878 195A STREET
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V4N5Y9
Mailing Address - Country:CA
Mailing Address - Phone:604-441-7399
Mailing Address - Fax:
Practice Address - Street 1:855 AARON DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9396
Practice Address - Country:US
Practice Address - Phone:808-224-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60323437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist