Provider Demographics
NPI:1629564414
Name:DAMON, EMILY KATE (MOT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATE
Last Name:DAMON
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5326
Mailing Address - Country:US
Mailing Address - Phone:253-334-1821
Mailing Address - Fax:
Practice Address - Street 1:12910 TOTEM LAKE BLVD NE STE 130
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2955
Practice Address - Country:US
Practice Address - Phone:425-823-8055
Practice Address - Fax:425-658-5302
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60822402224Z00000X
WAOT61496769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty