Provider Demographics
NPI:1538598826
Name:CARRIGAN, KATRINA (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 W FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8774
Mailing Address - Country:US
Mailing Address - Phone:231-394-1928
Mailing Address - Fax:
Practice Address - Street 1:600 DENMARK ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304-7500
Practice Address - Country:US
Practice Address - Phone:231-745-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007372224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant