Healthcare Provider Details

I. General information

NPI: 1346589090
Provider Name (Legal Business Name): CYNTHIA L KOTARSKI N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PREFONTAINE PL S STE 400
SEATTLE WA
98104-3299
US

IV. Provider business mailing address

3630 50TH AVE SW
SEATTLE WA
98116-3215
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-0851
  • Fax: 877-371-1974
Mailing address:
  • Phone: 716-462-8844
  • Fax: 206-420-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number60342361
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0991116
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: