Provider Demographics
NPI:1699370890
Name:KAMAL, AYESHA (COTA)
Entity type:Individual
Prefix:MRS
First Name:AYESHA
Middle Name:
Last Name:KAMAL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:AYESHA
Other - Middle Name:MAZHAR
Other - Last Name:ALEEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22525 NE 14TH DR
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6824
Mailing Address - Country:US
Mailing Address - Phone:206-403-8830
Mailing Address - Fax:
Practice Address - Street 1:2821 S WALDEN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6830
Practice Address - Country:US
Practice Address - Phone:206-403-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61005479224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant