Basic Information
| Provider Information | |||||||||
| NPI: | 1992715866 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEVISEUR | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 OLIVE WAY | ||||||||
| Address2: | MAIL STOP M4- PFS TRAINING | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065836025 | ||||||||
| FaxNumber: | 2065155886 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 OLIVE WAY | ||||||||
| Address2: | MAIL STOP M4- PFS TRAINING | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065836025 | ||||||||
| FaxNumber: | 2065155886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT00001398 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4673LE | 01 | WA | BLUE SHIELD # | OTHER | 8444895 | 05 | WA | MEDICAID | 95504U | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER |