Provider Demographics
NPI:1134129083
Name:WOLD, JEANNE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:WOLD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:ANN
Other - Last Name:SCHWENOHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2848
Mailing Address - Country:US
Mailing Address - Phone:206-323-5770
Mailing Address - Fax:206-328-6871
Practice Address - Street 1:1625 19TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2848
Practice Address - Country:US
Practice Address - Phone:206-323-5770
Practice Address - Fax:206-328-6871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0172057OtherLABOR AND INDUSTRIES
WA2158WOOtherREGENCE BLUE SHIELD
WA8345878Medicaid
WA8345878Medicaid