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General NPI Number Information
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NPI Number | 1922425123
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Entity Type | Individual
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Provider Name | KELLIE ANN HISLOP OTR/L, CHT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 510 8TH AVE NE STE 340
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City | ISSAQUAH
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State | WA
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Zip | 98029-5449
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Country | US
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Telephone | 425-313-3051
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Fax | 425-313-3055
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Provider Business Mailing Address
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Address Line | 510 8TH AVE NE STE 320
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City | ISSAQUAH
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State | WA
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Zip | 98029-5436
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Country | US
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Telephone | 425-313-3051
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Fax | 425-313-3055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | OT60514402
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60514402
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License Number State | WA
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