Healthcare Provider Details

I. General information

NPI: 1740262948
Provider Name (Legal Business Name): JENNIFER KAY OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY STACK

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 116TH AVE NE STE D4
BELLEVUE WA
98004-3058
US

IV. Provider business mailing address

12911 120TH AVE NE STE G10
KIRKLAND WA
98034-3048
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 TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00001614
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: