Provider Demographics
NPI:1932309846
Name:KING, JAIME LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYNN
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:BENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:321 BURDIN BLVD.
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-0680
Mailing Address - Country:US
Mailing Address - Phone:509-633-3260
Mailing Address - Fax:509-633-3212
Practice Address - Street 1:321 BURDIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-0680
Practice Address - Country:US
Practice Address - Phone:509-633-3260
Practice Address - Fax:509-633-3212
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003607225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802757OtherMEDICARE GROUP PIN
WA8404279Medicaid
WA8404279Medicaid
WAP67188Medicare UPIN