Provider Demographics
NPI:1639429244
Name:JERMULOWSKE, KATHI MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:MARIE
Last Name:JERMULOWSKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16409 65TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296
Mailing Address - Country:US
Mailing Address - Phone:425-218-0057
Mailing Address - Fax:
Practice Address - Street 1:16409 65TH AVE SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296
Practice Address - Country:US
Practice Address - Phone:425-218-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALA60299558224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant