Basic Information
| Provider Information | |||||||||
| NPI: | 1962557694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTCH | ||||||||
| FirstName: | JEANETTE | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | P.A.,C.; A.T., C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | OCEANS 9 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069871053 | ||||||||
| FaxNumber: | 2069873852 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 1ST AVE N | ||||||||
| Address2: | APT 316 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981095614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069871053 | ||||||||
| FaxNumber: | 2069873852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | A160047241 | WA | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | 363A00000X | PA60115674 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.