Basic Information
| Provider Information | |||||||||
| NPI: | 1942490727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UDDIN | ||||||||
| FirstName: | KRISTY | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253379556 | ||||||||
| FaxNumber: | 4253579186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253379556 | ||||||||
| FaxNumber: | 4253579186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT00004011 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2751UD | 01 | WA | REGENCE | OTHER | 0004UD | 01 | WA | REGENCE | OTHER | 4011UD | 01 | WA | REGENCE | OTHER | 3160UD | 01 | WA | REGENCE | OTHER | 8432981 | 01 | WA | DSHS | OTHER | 4161UD | 01 | WA | REGENCE | OTHER | 8949374 | 01 | WA | L&I CRIME | OTHER | 1061UD | 01 | WA | REGENCE | OTHER | 2494UD | 01 | WA | REGENCE | OTHER | 0241665 | 01 | WA | L&I | OTHER | 8948594 | 01 | WA | L&I CRIME | OTHER | 0239979 | 01 | WA | L&I | OTHER | 1942UD | 01 | WA | REGENCE | OTHER |