Healthcare Provider Details

I. General information

NPI: 1467755850
Provider Name (Legal Business Name): JAN MICHELLE KITTLESON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22813 CAREY RD SW
VASHON WA
98070-6819
US

IV. Provider business mailing address

22813 CAREY RD SW
VASHON WA
98070-6819
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-5788
  • Fax:
Mailing address:
  • Phone: 206-463-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number00001400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: