Provider Demographics
NPI:1669252490
Name:PARIS, JORDAN A (OTD)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:A
Last Name:PARIS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7683 SE 27TH ST STE 254
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2804
Mailing Address - Country:US
Mailing Address - Phone:425-999-3580
Mailing Address - Fax:425-531-7919
Practice Address - Street 1:1200 112TH AVE NE STE C210
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3740
Practice Address - Country:US
Practice Address - Phone:259-993-5804
Practice Address - Fax:425-999-3122
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61503884225XH1200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist