Provider Demographics
NPI:1679934541
Name:DEWAN, KAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:DEWAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W REDNOUR ST
Mailing Address - Street 2:
Mailing Address - City:OAKESDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99158-5000
Mailing Address - Country:US
Mailing Address - Phone:509-499-6051
Mailing Address - Fax:
Practice Address - Street 1:1620 SE SUMMIT CT
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5540
Practice Address - Country:US
Practice Address - Phone:509-332-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60628133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist