Provider Demographics
NPI:1740605971
Name:JARAMILLO, NICOLE LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:JARAMILLO
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 1:413 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-6428
Mailing Address - Country:US
Mailing Address - Phone:253-381-3406
Mailing Address - Fax:
Practice Address - Street 1:2929 5TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6782
Practice Address - Country:US
Practice Address - Phone:253-447-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60312487225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics