Healthcare Provider Details

I. General information

NPI: 1780549345
Provider Name (Legal Business Name): SEANNE MARAE BIALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

IV. Provider business mailing address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-7710
  • Fax: 425-483-6059
Mailing address:
  • Phone: 425-486-7710
  • Fax: 425-483-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.OT.70054389
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: