Healthcare Provider Details

I. General information

NPI: 1952914582
Provider Name (Legal Business Name): DANIEL OSCAR KRUPICKA OTR/L, C/NDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

IV. Provider business mailing address

11115 STATE AVE UNIT D103
MARYSVILLE WA
98271-7256
US

V. Phone/Fax

Practice location:
  • Phone: 360-325-3204
  • Fax:
Mailing address:
  • Phone: 360-325-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT61085894
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: