Provider Demographics
NPI:1104124650
Name:TAKEDA, JENNIFER S (OT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:TAKEDA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 252ND PL SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7756
Mailing Address - Country:US
Mailing Address - Phone:559-313-6399
Mailing Address - Fax:
Practice Address - Street 1:3546 252ND PL SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-7756
Practice Address - Country:US
Practice Address - Phone:559-313-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11323225X00000X
WAOT60498676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist