Healthcare Provider Details

I. General information

NPI: 1245548338
Provider Name (Legal Business Name): KATHLEEN MARIE NIELSEN OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 116TH AVE NE SUITE D-4
BELLEVUE WA
98004-3058
US

IV. Provider business mailing address

12911 120TH AVE NE STE H220
KIRKLAND WA
98034-3064
US

V. Phone/Fax

Practice location:
  • Phone: 425-283-5230
  • Fax: 425-283-5236
Mailing address:
  • Phone: 425-823-4224
  • Fax: 425-820-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00003441
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00003441
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: