MEDICARE: JESSICA KIERNAN

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
1	224Z00000X	Occupational Therapy Assistant	OC 60606696	WA

General Provider Information

NPI Number	:	1891168563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KIERNAN

Provider Business Mailing Address
First Line	:	14510 124TH AVE NE APT A6
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-1217
Country	:	US
Telephone Number	:	206-914-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	14510 124TH AVE NE APT A6
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-1217
Country	:	US
Telephone Number	:	206-914-1775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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Directions to “ JESSICA KIERNAN ” Practice Location

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