1518164904 NPI number — MRS. KATHLEEN MARIE WOOD MS OTR

Table of content: MRS. KATHLEEN MARIE WOOD MS OTR (NPI 1518164904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518164904 NPI number — MRS. KATHLEEN MARIE WOOD MS OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIVRET
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518164904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 BLUE HERON AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINBRIDGE ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98110-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-936-5642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 MADISON AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-842-4765
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2007

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: 225X00000X , with the licence number:  OT00003890 , 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)





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