Healthcare Provider Details

I. General information

NPI: 1104751205
Provider Name (Legal Business Name): VANESSA MARIE IGELSRUD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA MARIE GRIFFITH OT/L

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 AUBURN WAY N
AUBURN WA
98002-4109
US

IV. Provider business mailing address

5002 MILL POND LOOP SE
AUBURN WA
98092-3810
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-3405
  • Fax: 253-426-3096
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.OT.60663994
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: