Provider Demographics
NPI:1497223663
Name:PORTER, KEBRA RENEE (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:KEBRA
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:KEBRA
Other - Middle Name:RENEE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:4245 ROOSEVELT WAY NE FL 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6008
Mailing Address - Country:US
Mailing Address - Phone:206-598-0085
Mailing Address - Fax:206-598-4484
Practice Address - Street 1:4245 ROOSEVELT WAY NE FL 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-0085
Practice Address - Fax:206-598-4484
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61001766225XH1200X
OR409614225XH1200X
COOT.0006515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand