Provider Demographics
NPI:1275939506
Name:REINERTSEN, JERI LYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:LYN
Last Name:REINERTSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SYLVIA ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3020
Mailing Address - Country:US
Mailing Address - Phone:360-249-3202
Mailing Address - Fax:360-249-3202
Practice Address - Street 1:301 N SYLVIA ST
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3020
Practice Address - Country:US
Practice Address - Phone:360-249-3202
Practice Address - Fax:360-249-3202
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist