Provider Demographics
NPI:1669723078
Name:VAUGHN, JENNIFER M (OTD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22443 SE 240TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5846
Mailing Address - Country:US
Mailing Address - Phone:425-358-3070
Mailing Address - Fax:
Practice Address - Street 1:22443 SE 240TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5846
Practice Address - Country:US
Practice Address - Phone:425-358-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61476101225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist