Provider Demographics
NPI:1285105627
Name:DOAK, JARED WILLIAM
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:DOAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3101
Mailing Address - Country:US
Mailing Address - Phone:206-479-9454
Mailing Address - Fax:
Practice Address - Street 1:7900 WILLOWS RD NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6813
Practice Address - Country:US
Practice Address - Phone:425-885-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR353557225X00000X
WAOT60633464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist