Provider Demographics
NPI:1275858995
Name:HALING JENSEN, MARY KAY (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:HALING JENSEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KAY
Other - Last Name:HALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3625 289TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-9167
Mailing Address - Country:US
Mailing Address - Phone:425-289-6863
Mailing Address - Fax:
Practice Address - Street 1:3625 289TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-9167
Practice Address - Country:US
Practice Address - Phone:425-289-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist