Provider Demographics
NPI:1306613005
Name:FAUSETT, KLARIN LEANN (COTA/L)
Entity type:Individual
Prefix:
First Name:KLARIN
Middle Name:LEANN
Last Name:FAUSETT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 CHERRY TREE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7040
Mailing Address - Country:US
Mailing Address - Phone:916-599-9334
Mailing Address - Fax:
Practice Address - Street 1:3128 CHERRY TREE CIR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7040
Practice Address - Country:US
Practice Address - Phone:916-599-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61369541224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant