Healthcare Provider Details

I. General information

NPI: 1295431328
Provider Name (Legal Business Name): MOLLIE MADISON VOIGT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17825 59TH AVE NE STE B
ARLINGTON WA
98223-6453
US

IV. Provider business mailing address

17825 59TH AVE NE STE B
ARLINGTON WA
98223-6453
US

V. Phone/Fax

Practice location:
  • Phone: 360-363-4234
  • Fax: 360-363-4235
Mailing address:
  • Phone: 360-363-4234
  • Fax: 360-363-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61416859
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCG61396374
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: