Healthcare Provider Details

I. General information

NPI: 1346584604
Provider Name (Legal Business Name): MARTHA KELLEY HESCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA KELLEY CADY OTR/L

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MONTE VILLA PKWY
BOTHELL WA
98021-8972
US

IV. Provider business mailing address

5218 S PEARL ST
SEATTLE WA
98118-2148
US

V. Phone/Fax

Practice location:
  • Phone: 425-408-4064
  • Fax:
Mailing address:
  • Phone: 206-325-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number00000811
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: