Provider Demographics
NPI:1588013668
Name:JARVIS, JOSEPHINE (MA, OTR-L)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:MA, OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24039 SE 203RD ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8907
Mailing Address - Country:US
Mailing Address - Phone:425-765-2663
Mailing Address - Fax:
Practice Address - Street 1:24039 SE 203RD ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8907
Practice Address - Country:US
Practice Address - Phone:425-765-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60625625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist