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NPI Code Detail

MEDICARE: KERWIN JOHN DOUGHTON OTR/L

MEDICARE: KERWIN JOHN DOUGHTON OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT 00003047WA

General Provider Information

NPI Number : 1053649012
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERWIN JOHN DOUGHTON OTR/L
Provider Business Mailing Address
First Line : 4701 73RD AVENUE CT W
Second Line :
City : UNIVERSITY PLACE
State : WA
Zip : 98466-4244
Country : US
Telephone Number : 253-565-7222
Fax Number :
Provider Business Practice Location Address
First Line : 9601 STEILACOOM BLVD SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98498-7212
Country : US
Telephone Number : 253-756-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2009
Last Update Date : 12/02/2009

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