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NPI Code Detail

MEDICARE: MIRA WASZAK OT

MEDICARE:   MIRA  WASZAK  OT
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 TherapistOT3335WA

General Provider Information

NPI Number : 1891807582
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRA WASZAK OT
Provider Business Mailing Address
First Line : 515 KIRKLAND WAY
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-6219
Country : US
Telephone Number : 425-827-7031
Fax Number : 425-827-0102
Provider Business Practice Location Address
First Line : 515 KIRKLAND WAY
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-6219
Country : US
Telephone Number : 425-827-7031
Fax Number : 425-827-0102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ MIRA WASZAK OT” Practice Location

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