Healthcare Provider Details

I. General information

NPI: 1295165827
Provider Name (Legal Business Name): PATRICIA M JENNINGS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 3RD AVE S MS:31-680
SEATTLE WA
98134-1923
US

IV. Provider business mailing address

14110 SE 171ST WAY APT B101
RENTON WA
98058-8819
US

V. Phone/Fax

Practice location:
  • Phone: 206-229-2537
  • Fax: 435-572-5448
Mailing address:
  • Phone: 206-229-2537
  • Fax: 435-572-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60419888
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: