Healthcare Provider Details

I. General information

NPI: 1891509956
Provider Name (Legal Business Name): MARTHA JANE PEAD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12826 SE 40TH LN STE A10
BELLEVUE WA
98006-5266
US

IV. Provider business mailing address

821 S WASHINGTON ST APT 322
SEATTLE WA
98104-3332
US

V. Phone/Fax

Practice location:
  • Phone: 206-409-6319
  • Fax:
Mailing address:
  • Phone: 817-437-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-20-119291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: