Healthcare Provider Details

I. General information

NPI: 1396838967
Provider Name (Legal Business Name): JESSICA MARKOWITZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARKET ST NE SUITE 108
OLYMPIA WA
98501
US

IV. Provider business mailing address

1830 BICKFORD AVE SUITE 209
SNOHOMISH WA
98290
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-7085
  • Fax: 360-754-3671
Mailing address:
  • Phone: 425-330-0633
  • Fax: 360-568-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: