Provider Demographics
NPI:1548319643
Name:OCEAN, PATRICIA ESTELLE KELSO (MSOT, OTR/L, LMT,)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ESTELLE KELSO
Last Name:OCEAN
Suffix:
Gender:F
Credentials:MSOT, OTR/L, LMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 PEAR ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3536
Mailing Address - Country:US
Mailing Address - Phone:360-507-0524
Mailing Address - Fax:
Practice Address - Street 1:404 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1457
Practice Address - Country:US
Practice Address - Phone:360-507-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016377225700000X
WAOT60378531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161131OtherLABOR AND INDUSTRIES