Provider Demographics
NPI:1720371768
Name:KETNER, KARI LYNN (OT)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:LYNN
Last Name:KETNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3788
Mailing Address - Country:US
Mailing Address - Phone:425-317-9119
Mailing Address - Fax:425-317-9118
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3787
Practice Address - Country:US
Practice Address - Phone:425-317-9119
Practice Address - Fax:425-317-9118
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATL60216002225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0281639OtherL & I
WA0281855OtherL & I
WA0281859OtherL & I
WA0281855OtherL & I
WA0281859OtherL & I
WAG8902008Medicare PIN