Provider Demographics
NPI:1922342724
Name:FRIDENSTINE, JOANN TESSITORE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:TESSITORE
Last Name:FRIDENSTINE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17819 NE 96TH WAY
Mailing Address - Street 2:1
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6955
Mailing Address - Country:US
Mailing Address - Phone:425-765-8344
Mailing Address - Fax:
Practice Address - Street 1:8001 SILVA AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-0400
Practice Address - Country:US
Practice Address - Phone:425-831-8000
Practice Address - Fax:425-831-8040
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000987225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00000987OtherOCCUPATIONAL THERAPIST LISCENSE