Provider Demographics
NPI:1396175253
Name:DONNDELINGER, KELLY (MOTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DONNDELINGER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:17156 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5314
Mailing Address - Country:US
Mailing Address - Phone:206-947-6637
Mailing Address - Fax:
Practice Address - Street 1:925 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-947-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60713087225X00000X
MN104434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist