Provider Demographics
NPI:1770060568
Name:FREED, JASON (OTR/L)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FREED
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1250 NE 145TH ST.
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155
Mailing Address - Country:US
Mailing Address - Phone:206-365-0568
Mailing Address - Fax:
Practice Address - Street 1:1250 NE 145TH ST.
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155
Practice Address - Country:US
Practice Address - Phone:206-365-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225X00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1006722Medicaid