Provider Demographics
NPI:1679856512
Name:OTIS, KIMBERLY C (ND)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:C
Last Name:OTIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11903 NE 128TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7209
Mailing Address - Country:US
Mailing Address - Phone:425-825-8088
Mailing Address - Fax:425-825-1406
Practice Address - Street 1:11903 NE 128TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7209
Practice Address - Country:US
Practice Address - Phone:425-825-8088
Practice Address - Fax:425-825-1406
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1123175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath