Provider Demographics
NPI:1629016720
Name:MAKI, JAMIE (THERAPIST)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0845
Mailing Address - Country:US
Mailing Address - Phone:406-370-0223
Mailing Address - Fax:
Practice Address - Street 1:4601 NE 77TH AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6729
Practice Address - Country:US
Practice Address - Phone:360-514-9271
Practice Address - Fax:360-397-0777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist