1922342724 NPI number — JOANN TESSITORE FRIDENSTINE OTR/L

Table of content: JOANN TESSITORE FRIDENSTINE OTR/L (NPI 1922342724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922342724 NPI number — JOANN TESSITORE FRIDENSTINE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIDENSTINE
Provider First Name:
JOANN
Provider Middle Name:
TESSITORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922342724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17819 NE 96TH WAY
Provider Second Line Business Mailing Address:
1
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-6955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-765-8344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 SILVA AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNOQUALMIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98065-0400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-831-8000
Provider Business Practice Location Address Fax Number:
425-831-8040
Provider Enumeration Date:
11/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  00000987 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00000987 . This is a "OCCUPATIONAL THERAPIST LISCENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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