Provider Demographics
NPI:1467755850
Name:KITTLESON, JAN MICHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MICHELLE
Last Name:KITTLESON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22813 CAREY RD SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6819
Mailing Address - Country:US
Mailing Address - Phone:206-463-5788
Mailing Address - Fax:
Practice Address - Street 1:22813 CAREY RD SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6819
Practice Address - Country:US
Practice Address - Phone:206-463-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001400225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT 00001400OtherWASHINGTON STATE DEPARTMENT OF HEALTH