Healthcare Provider Details

I. General information

NPI: 1255838033
Provider Name (Legal Business Name): THREE TREES PEDIATRIC OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14630 8TH AVE SW
BURIEN WA
98166-1953
US

IV. Provider business mailing address

14630 8TH AVE SW
BURIEN WA
98166-1953
US

V. Phone/Fax

Practice location:
  • Phone: 253-468-1325
  • Fax:
Mailing address:
  • Phone: 253-468-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number604146099
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH MULHOLLAND
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 253-468-1325