Healthcare Provider Details

I. General information

NPI: 1134129083
Provider Name (Legal Business Name): JEANNE ANN WOLD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JEANNE ANN SCHWENOHA

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 19TH AVE
SEATTLE WA
98122-2848
US

IV. Provider business mailing address

1625 19TH AVE
SEATTLE WA
98122-2848
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-5770
  • Fax: 206-328-6871
Mailing address:
  • Phone: 206-323-5770
  • Fax: 206-328-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00002990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: