Provider Demographics
NPI:1689964678
Name:BERTRAND, KIM A (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 MULLIS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-7902
Mailing Address - Country:US
Mailing Address - Phone:360-370-5226
Mailing Address - Fax:
Practice Address - Street 1:669 MULLIS ST STE 102
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7902
Practice Address - Country:US
Practice Address - Phone:360-370-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60204456224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant