Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00003756 | WA |
N | 225XH1200X | Occupational Therapist - Hand | OT00003759 | WA |
NPI | 1043264518 |
---|---|
Provider Name | Sharon Lynn Kuznetsov |
First Address | Bainbridge Island, WA 98110-1768 |
Second Address | Bainbridge Island, WA 98110-1768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8379364 | (05) | WA |
G8948780 | MEDICARE (01) | WA |
P00264836 | RAILROAD MEDICARE (01) |