Provider Demographics
NPI:1578063434
Name:GOLOB, JON-ERIK (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JON-ERIK
Middle Name:
Last Name:GOLOB
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13804 NE 70TH PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-9427
Mailing Address - Country:US
Mailing Address - Phone:360-329-2034
Mailing Address - Fax:
Practice Address - Street 1:7900 WILLOWS RD NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6813
Practice Address - Country:US
Practice Address - Phone:425-885-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60817748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist