Individual
MCKINZI M PONTIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2211 NE 139TH ST, VANCOUVER, WA 98686-2742
(360) 487-1777
Mailing address
807 LONE OAK RD, LONGVIEW, WA 98632-9558
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
396106
NBCOT
—
01
—
OT60827942
WASHINGTON STATE DEPT. OF HEALTH
WA
Enumeration date
01/29/2018
Last updated
12/02/2021
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