Healthcare Provider Details

I. General information

NPI: 1083377857
Provider Name (Legal Business Name): KRISTEN ELAINE ZORN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18504 BOTHELL WAY NE
BOTHELL WA
98011-1927
US

IV. Provider business mailing address

18504 BOTHELL WAY NE
BOTHELL WA
98011-1927
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-1933
  • Fax:
Mailing address:
  • Phone: 425-481-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberOC61223176
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: