Provider Demographics
NPI:1215988951
Name:OTTAWAY, KATHERINE T (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:T
Last Name:OTTAWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-7925
Mailing Address - Country:US
Mailing Address - Phone:360-385-3826
Mailing Address - Fax:360-385-3537
Practice Address - Street 1:2120 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-7925
Practice Address - Country:US
Practice Address - Phone:360-385-3826
Practice Address - Fax:360-385-3537
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109776Medicaid
WA1109776Medicaid
WAG34936Medicare UPIN