Healthcare Provider Details

I. General information

NPI: 1689290538
Provider Name (Legal Business Name): KRISTINE DENISE SPURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 3RD AVE S
SEATTLE WA
98134-1923
US

IV. Provider business mailing address

8612 PALATINE AVE N APT 601
SEATTLE WA
98103-3995
US

V. Phone/Fax

Practice location:
  • Phone: 206-252-0000
  • Fax:
Mailing address:
  • Phone: 707-495-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number61069341
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: