Provider Demographics
NPI:1407244510
Name:LACKOWSKI, KARA (MSOT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:LACKOWSKI
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 WALLINGFORD AVE N
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1495 NW GILMAN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8975
Practice Address - Country:US
Practice Address - Phone:425-392-2346
Practice Address - Fax:425-392-0185
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60337680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist