Provider Demographics
NPI:1912399734
Name:SEITZ, KRYSTAL MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:SEITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:NAIRNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-1220
Mailing Address - Country:US
Mailing Address - Phone:541-999-5442
Mailing Address - Fax:
Practice Address - Street 1:2219 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2171
Practice Address - Country:US
Practice Address - Phone:509-235-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60534328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist