Provider Demographics
NPI:1891988127
Name:SCHIMKE, KRISTEN DIANE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DIANE
Last Name:SCHIMKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:DIANE
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2595
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-2595
Mailing Address - Country:US
Mailing Address - Phone:425-588-1130
Mailing Address - Fax:
Practice Address - Street 1:12835 NE BEL RED RD STE 303
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-588-1130
Practice Address - Fax:425-615-7779
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12879225X00000X
AK1228225X00000X
WA00003045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000343600Medicaid
FL892912200Medicaid
AKOT12281Medicaid