Healthcare Provider Details

I. General information

NPI: 1235285347
Provider Name (Legal Business Name): BOTHELL PEDIATRIC & HAND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18504 - BOTHELL WAY NE
BOTHELL WA
98011
US

IV. Provider business mailing address

18504 BOTHELL WAY NE
BOTHELL WA
98011
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-1933
  • Fax: 425-481-9371
Mailing address:
  • Phone: 425-481-1933
  • Fax: 425-481-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007305
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00008794
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00001174
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00001174
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004467
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00002828
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8432916
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier7128762
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 3
Identifier8430985
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier7682149
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 5
Identifier8399354
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 6
Identifier7124241
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 7
Identifier8399347
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: KIMBERLY ANN ALQUIST
Title or Position: OWNER
Credential: OTRL / CHT
Phone: 425-481-1933