Provider Demographics
NPI:1326223462
Name:MOCK, JENNIFER LEIGH (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MOCK
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 1:100 DENNIS ST SW
Mailing Address - Street 2:STE B
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:509-624-2353
Mailing Address - Fax:509-624-2501
Practice Address - Street 1:601 W 5TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2714
Practice Address - Country:US
Practice Address - Phone:509-624-2353
Practice Address - Fax:509-624-2501
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATL10000801225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7680325Medicaid
WA99960OtherDEPT. OF LABOR & INDUSTRY
WA7680325Medicaid