Healthcare Provider Details

I. General information

NPI: 1003576257
Provider Name (Legal Business Name): FIDALGO ISLAND PEDIATRIC OCCUPATIONAL THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 01/01/2022
Certification Date: 01/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 MEADOWS LN
ANACORTES WA
98221-1170
US

IV. Provider business mailing address

2116 MEADOWS LN
ANACORTES WA
98221-1170
US

V. Phone/Fax

Practice location:
  • Phone: 206-819-3905
  • Fax:
Mailing address:
  • Phone: 206-819-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLENE NICHOLS
Title or Position: OWNER
Credential: OTR/L
Phone: 206-819-3905