Healthcare Provider Details

I. General information

NPI: 1295650547
Provider Name (Legal Business Name): IRIS SIOBHAN DONOHUE NOSEK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22978 SEATTER RD
KINGSTON WA
98346
US

IV. Provider business mailing address

12117 DAPHNE LN NW APT H208
SILVERDALE WA
98383-8603
US

V. Phone/Fax

Practice location:
  • Phone: 360-209-3174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.OT.70148189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: