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NPI Code Detail

MEDICARE: YVETTE PHAN

MEDICARE:   YVETTE  PHAN
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
1225X00000XOccupational Therapist60822577WA

General Provider Information

NPI Number : 1710468772
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVETTE PHAN
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY STE 100
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4628
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1649 E 72ND ST
Second Line :
City : TACOMA
State : WA
Zip : 98404-5402
Country : US
Telephone Number : 253-472-9027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 08/27/2018

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Directions to “ YVETTE PHAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.