Provider Demographics
NPI:1144706698
Name:KIM, DEAN EUIJEONG (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:EUIJEONG
Last Name:KIM
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REHABILITATION THERAPIES
Mailing Address - Street 2:914 S. SCHEUBER RD
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-330-8720
Mailing Address - Fax:360-330-8737
Practice Address - Street 1:REHABILITATION THERAPIES
Practice Address - Street 2:914 S. SCHEUBER RD
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-330-8720
Practice Address - Fax:360-330-8737
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60595829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKIME178CZOtherDRIVER LICENSE NUMBER