Provider Demographics
NPI:1083815724
Name:KRIST, JODI ANN (COTA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:KRIST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21317 125TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2265
Mailing Address - Country:US
Mailing Address - Phone:206-972-8672
Mailing Address - Fax:
Practice Address - Street 1:1031 SW 130TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-3132
Practice Address - Country:US
Practice Address - Phone:206-242-3213
Practice Address - Fax:206-242-0528
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant