Healthcare Provider Details

I. General information

NPI: 1447269196
Provider Name (Legal Business Name): WILLIAM E OTTAVIANI MS, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39618 MERIDIAN E
EATONVILLE WA
98328-9041
US

IV. Provider business mailing address

39618 MERIDIAN E
EATONVILLE WA
98328-9041
US

V. Phone/Fax

Practice location:
  • Phone: 360-832-8875
  • Fax:
Mailing address:
  • Phone: 360-832-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: