Healthcare Provider Details

I. General information

NPI: 1609175322
Provider Name (Legal Business Name): ROXANNE OLIVEROS FERNANDEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18504 BOTHELL WAY NE
BOTHELL WA
98011-1927
US

IV. Provider business mailing address

18504 BOTHELL WAY NE
BOTHELL WA
98011-1927
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 TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT60202023
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: