Provider Demographics
NPI:1174050967
Name:KONING, CLAIRE ELISE JACKSON (MOTR/L)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELISE JACKSON
Last Name:KONING
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELISE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 SUMMIT AVE E
Mailing Address - Street 2:#204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4850
Mailing Address - Country:US
Mailing Address - Phone:630-247-3638
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX NUMBER 359897
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60737466225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation