MEDICARE: VICTORIA ITO OTR/L

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	225X00000X	Occupational Therapist	OT60922705	WA

General Provider Information

NPI Number	:	1497213516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ITO OTR/L

Provider Business Mailing Address
First Line	:	215 13TH AVE E APT 209
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-5867
Country	:	US
Telephone Number	:	847-400-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-7709
Country	:	US
Telephone Number	:	206-520-5000
Fax Number	:

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	10/26/2023

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Directions to “ VICTORIA ITO OTR/L” Practice Location

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