=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003634569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASDEEP KAUR OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 WASHINGTON AVE S
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98032-5767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-850-9780
-----------------------------------------------------
Fax | 253-850-6445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27623 154TH PL SE
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-499-9357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT61577015
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------