Provider Demographics
NPI:1457690992
Name:KOZIOL, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 4TH AVE NE APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6441
Mailing Address - Country:US
Mailing Address - Phone:206-240-4205
Mailing Address - Fax:
Practice Address - Street 1:6510 4TH AVE NE APT 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6441
Practice Address - Country:US
Practice Address - Phone:206-240-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00018629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist