Individual
KYLIE R FORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
906 SE EVERETT MALL WAY STE 200, EVERETT, WA 98208-3743
(425) 353-5656
(425) 513-2807
Mailing address
14 E CASINO RD STE A, EVERETT, WA 98208-2628
(425) 353-5656
(425) 513-2807
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT60842445
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100391
—
WA
Enumeration date
05/08/2018
Last updated
12/30/2019
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