Healthcare Provider Details

I. General information

NPI: 1285656256
Provider Name (Legal Business Name): NORTHWEST HAND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 GRIFFIN AVE STE 110
ENUMCLAW WA
98022-2373
US

IV. Provider business mailing address

PO BOX 97115
LAKEWOOD WA
98497-0115
US

V. Phone/Fax

Practice location:
  • Phone: 360-802-6838
  • Fax: 360-802-6839
Mailing address:
  • Phone: 253-588-7911
  • Fax: 253-984-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberOT00002354
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT00002354
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SUSAN D LOUIE
Title or Position: OWNER
Credential: OTR/L
Phone: 360-802-6838