Provider Demographics
NPI:1518031467
Name:MERTENS, KRISTA BETH (OT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:BETH
Last Name:MERTENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 CORPORATE CENTER CT SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5952
Mailing Address - Country:US
Mailing Address - Phone:360-455-8155
Mailing Address - Fax:360-455-1655
Practice Address - Street 1:3801 5TH ST SE STE 220
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2106
Practice Address - Country:US
Practice Address - Phone:253-445-4258
Practice Address - Fax:253-445-4724
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001454225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0264702OtherDEPT OF L&I
WA0319MEOtherREGENCE
WA1518031467OtherDSHS
WA8368946Medicaid
LI0192217OtherLABOR & INDUSTRIES
WA1518031467OtherDSHS
WA8368946Medicaid