Provider Demographics
NPI:1730745639
Name:CARBAJO, KATHERINE ANNE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:CARBAJO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 BRAHMS CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4894
Mailing Address - Country:US
Mailing Address - Phone:248-961-9890
Mailing Address - Fax:
Practice Address - Street 1:3101 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4515
Practice Address - Country:US
Practice Address - Phone:775-433-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist