MEDICARE: MS. CHERYL KLIKAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OC00000499	WA

General Provider Information

NPI Number	:	1376741470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL KLIKAS

Provider Business Mailing Address
First Line	:	29811 S CREEK RD E
Second Line	:
City	:	GRAHAM
State	:	WA
Zip	:	98338-7920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 CAPITOL MALL DR SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8657
Country	:	US
Telephone Number	:	360-754-9792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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