Provider Demographics
NPI:1861250573
Name:LAGON, JOVELYN
Entity type:Individual
Prefix:
First Name:JOVELYN
Middle Name:
Last Name:LAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 S 258TH PL APT 311
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6388
Mailing Address - Country:US
Mailing Address - Phone:206-384-7789
Mailing Address - Fax:
Practice Address - Street 1:8723 S 258TH PL APT 311
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6388
Practice Address - Country:US
Practice Address - Phone:206-384-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA400791224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant