Provider Demographics
NPI:1164883666
Name:WINTERS, KJIRSTEN ERICA (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KJIRSTEN
Middle Name:ERICA
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34616 11TH PL S STE 1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8705
Mailing Address - Country:US
Mailing Address - Phone:253-874-7842
Mailing Address - Fax:253-874-7109
Practice Address - Street 1:34616 11TH PL S STE 1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-874-7842
Practice Address - Fax:253-874-7109
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60552139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist