Provider Demographics
NPI:1538418538
Name:KRAUS, MARIEL CASTANEDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARIEL
Middle Name:CASTANEDA
Last Name:KRAUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 OLYMPIC DRIVE, H105
Mailing Address - Street 2:#101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-514-6842
Mailing Address - Fax:253-514-6863
Practice Address - Street 1:5775 SOUNDVIEW DR
Practice Address - Street 2:A-103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2211
Practice Address - Country:US
Practice Address - Phone:253-514-6842
Practice Address - Fax:253-514-6863
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003975225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8946103OtherPTAN