Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 60454542 | WA |
NPI | 1003213067 |
---|---|
Provider Name | Jennifer Dawn Colwell |
First Address | Tacoma, WA 98405-1953 |
Second Address | Tacoma, WA 98405-1953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2014 |
Last Update Date | 24/05/2019 |